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Garber HR, Basu S, Jindal S, He Z, Chu K, Raghavendra AS, Yam C, Santiago L, Adrada BE, Sharma P, Mittendorf EA, Litton JK. Durvalumab and tremelimumab before surgery in patients with hormone receptor positive, HER2-negative stage II-III breast cancer. Oncotarget 2024; 15:238-247. [PMID: 38502947 PMCID: PMC10950364 DOI: 10.18632/oncotarget.28567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
A clinical trial was conducted to assess the feasibility of enrolling patients with Stage II or III hormone receptor positive (HR+)/HER2-negative breast cancer to pre-operative dual PD-L1/CTLA-4 checkpoint inhibition administered prior to neoadjuvant chemotherapy (NACT). Eight eligible patients were treated with upfront durvalumab and tremelimumab for two cycles. Patients then received NACT prior to breast surgery. Seven patients had baseline and interval breast ultrasounds after combination immunotherapy and the responses were mixed: 3/7 patients experienced a ≥30% decrease in tumor volume, 3/7 a ≥30% increase, and 1 patient had stable disease. At the time of breast surgery, 1/8 patients had a pathologic complete response (pCR). The trial was stopped early after 3 of 8 patients experienced immunotherapy-related toxicity or suspected disease progression that prompted discontinuation or a delay in the administration of NACT. Two patients experienced grade 3 immune-related adverse events (1 with colitis, 1 with endocrinopathy). Analysis of the tumor microenvironment after combination immunotherapy did not show a significant change in immune cell subsets from baseline. There was limited benefit for dual checkpoint blockade administered prior to NACT in our study of 8 patients with HR+/HER2-negative breast cancer.
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Affiliation(s)
- Haven R. Garber
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sreyashi Basu
- Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sonali Jindal
- Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zhong He
- Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Khoi Chu
- Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Clinton Yam
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lumarie Santiago
- Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Beatriz E. Adrada
- Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Padmanee Sharma
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elizabeth A. Mittendorf
- Department of Surgery, Division of Breast Surgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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2
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Basho RK, Zhao L, White JB, Huo L, Bassett RL, Mittendorf EA, Thompson A, Litton JK, Ueno N, Arun B, Lim B, Valero V, Tripathy D, Zhang J, Adrada BE, Santiago L, Ravenberg E, Seth S, Yam C, Moulder SL, Damodaran S. Comprehensive Analysis Identifies Variability in PI3K Pathway Alterations in Triple-Negative Breast Cancer Subtypes. JCO Precis Oncol 2024; 8:e2300124. [PMID: 38484209 PMCID: PMC10954064 DOI: 10.1200/po.23.00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/10/2023] [Accepted: 11/16/2023] [Indexed: 03/19/2024] Open
Abstract
PURPOSE The PI3K pathway is frequently altered in triple-negative breast cancer (TNBC). Limited cell line and human data suggest that TNBC tumors characterized as mesenchymal (M) and luminal androgen receptor (LAR) subtypes have increased incidence of alterations in the PI3K pathway. The impact of PI3K pathway alterations across TNBC subtypes is poorly understood. METHODS Pretreatment tumor was evaluated from operable TNBC patients enrolled on a clinical trial of neoadjuvant therapy (NAT; A Robust TNBC Evaluation fraMework to Improve Survival [ClinicalTrials.gov identifier: NCT02276443]). Tumors were characterized into seven TNBC subtypes per Pietenpol criteria (basal-like 1, basal-like 2, immunomodulatory, M, mesenchymal stem-like, LAR, and unstable). Using whole-exome sequencing, RNA sequencing, and immunohistochemistry for PTEN, alterations were identified in 32 genes known to activate the PI3K pathway. Alterations in each subtype were associated with pathologic response to NAT. RESULTS In evaluated patients (N = 177), there was a significant difference in the incidence of PI3K pathway alterations across TNBC subtypes (P < .01). The highest incidence of alterations was seen in LAR (81%), BL2 (79%), and M (62%) subtypes. The odds ratio for pathologic complete response (pCR) in the presence of PIK3CA mutation, PTEN mutation, and/or PTEN loss was highest in the LAR subtype and lowest in the M subtype, but these findings did not reach statistical significance. Presence of PIK3CA mutation was associated with pCR in the LAR subtype (P = .02). CONCLUSION PI3K pathway alteration can affect response to NAT in TNBC, and targeted agents may improve outcomes, particularly in patients with M and LAR TNBC.
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Affiliation(s)
| | - Li Zhao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason B. White
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Huo
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Naoto Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
- University of Hawaii Cancer Center, Honolulu, HI
| | - Banu Arun
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bora Lim
- Baylor College of Medicine, Houston, TX
| | - Vicente Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debu Tripathy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jianhua Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Sahil Seth
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Clinton Yam
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stacy L. Moulder
- University of Texas MD Anderson Cancer Center, Houston, TX
- Eli Lilly and Company, Indianapolis, IN
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3
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Musall BC, Rauch DE, Mohamed RMM, Panthi B, Boge M, Candelaria RP, Chen H, Guirguis MS, Hunt KK, Huo L, Hwang KP, Korkut A, Litton JK, Moseley TW, Pashapoor S, Patel MM, Reed BJ, Scoggins ME, Son JB, Tripathy D, Valero V, Wei P, White JB, Whitman GJ, Xu Z, Yang WT, Yam C, Adrada BE, Ma J. Diffusion Tensor Imaging for Characterizing Changes in Triple-Negative Breast Cancer During Neoadjuvant Systemic Therapy. J Magn Reson Imaging 2024. [PMID: 38294179 DOI: 10.1002/jmri.29267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Assessment of treatment response in triple-negative breast cancer (TNBC) may guide individualized care for improved patient outcomes. Diffusion tensor imaging (DTI) measures tissue anisotropy and could be useful for characterizing changes in the tumors and adjacent fibroglandular tissue (FGT) of TNBC patients undergoing neoadjuvant systemic treatment (NAST). PURPOSE To evaluate the potential of DTI parameters for prediction of treatment response in TNBC patients undergoing NAST. STUDY TYPE Prospective. POPULATION Eighty-six women (average age: 51 ± 11 years) with biopsy-proven clinical stage I-III TNBC who underwent NAST followed by definitive surgery. 47% of patients (40/86) had pathologic complete response (pCR). FIELD STRENGTH/SEQUENCE 3.0 T/reduced field of view single-shot echo-planar DTI sequence. ASSESSMENT Three MRI scans were acquired longitudinally (pre-treatment, after 2 cycles of NAST, and after 4 cycles of NAST). Eleven histogram features were extracted from DTI parameter maps of tumors, a peritumoral region (PTR), and FGT in the ipsilateral breast. DTI parameters included apparent diffusion coefficients and relative diffusion anisotropies. pCR status was determined at surgery. STATISTICAL TESTS Longitudinal changes of DTI features were tested for discrimination of pCR using Mann-Whitney U test and area under the receiver operating characteristic curve (AUC). A P value <0.05 was considered statistically significant. RESULTS 47% of patients (40/86) had pCR. DTI parameters assessed after 2 and 4 cycles of NAST were significantly different between pCR and non-pCR patients when compared between tumors, PTRs, and FGTs. The median surface/average anisotropy of the PTR, measured after 2 and 4 cycles of NAST, increased in pCR patients and decreased in non-pCR patients (AUC: 0.78; 0.027 ± 0.043 vs. -0.017 ± 0.042 mm2 /s). DATA CONCLUSION Quantitative DTI features from breast tumors and the peritumoral tissue may be useful for predicting the response to NAST in TNBC. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Benjamin C Musall
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David E Rauch
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rania M M Mohamed
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bikash Panthi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Medine Boge
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rosalind P Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Huiqin Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary S Guirguis
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anil Korkut
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tanya W Moseley
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanaz Pashapoor
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Miral M Patel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brandy J Reed
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marion E Scoggins
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary J Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhan Xu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei T Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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4
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Panthi B, Mohamed RM, Adrada BE, Boge M, Candelaria RP, Chen H, Hunt KK, Huo L, Hwang KP, Korkut A, Lane DL, Le-Petross HC, Leung JWT, Litton JK, Pashapoor S, Perez F, Son JB, Sun J, Thompson A, Tripathy D, Valero V, Wei P, White J, Xu Z, Yang W, Zhou Z, Yam C, Rauch GM, Ma J. Longitudinal dynamic contrast-enhanced MRI radiomic models for early prediction of response to neoadjuvant systemic therapy in triple-negative breast cancer. Front Oncol 2023; 13:1264259. [PMID: 37941561 PMCID: PMC10628525 DOI: 10.3389/fonc.2023.1264259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Early prediction of neoadjuvant systemic therapy (NAST) response for triple-negative breast cancer (TNBC) patients could help oncologists select individualized treatment and avoid toxic effects associated with ineffective therapy in patients unlikely to achieve pathologic complete response (pCR). The objective of this study is to evaluate the performance of radiomic features of the peritumoral and tumoral regions from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) acquired at different time points of NAST for early treatment response prediction in TNBC. This study included 163 Stage I-III patients with TNBC undergoing NAST as part of a prospective clinical trial (NCT02276443). Peritumoral and tumoral regions of interest were segmented on DCE images at baseline (BL) and after two (C2) and four (C4) cycles of NAST. Ten first-order (FO) radiomic features and 300 gray-level-co-occurrence matrix (GLCM) features were calculated. Area under the receiver operating characteristic curve (AUC) and Wilcoxon rank sum test were used to determine the most predictive features. Multivariate logistic regression models were used for performance assessment. Pearson correlation was used to assess intrareader and interreader variability. Seventy-eight patients (48%) had pCR (52 training, 26 testing), and 85 (52%) had non-pCR (57 training, 28 testing). Forty-six radiomic features had AUC at least 0.70, and 13 multivariate models had AUC at least 0.75 for training and testing sets. The Pearson correlation showed significant correlation between readers. In conclusion, Radiomic features from DCE-MRI are useful for differentiating pCR and non-pCR. Similarly, predictive radiomic models based on these features can improve early noninvasive treatment response prediction in TNBC patients undergoing NAST.
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Affiliation(s)
- Bikash Panthi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rania M. Mohamed
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Beatriz E. Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Medine Boge
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Koc University Hospital, Istanbul, Türkiye
| | - Rosalind P. Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Huiqin Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anil Korkut
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Deanna L. Lane
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Huong C. Le-Petross
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jessica W. T. Leung
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sanaz Pashapoor
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Frances Perez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alastair Thompson
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jason White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zhan Xu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Wei Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zijian Zhou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gaiane M. Rauch
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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5
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Litton JK, Beck JT, Jones JM, Andersen J, Blum JL, Mina LA, Brig R, Danso M, Yuan Y, Abbattista A, Noonan K, Niyazov A, Chakrabarti J, Czibere A, Symmans WF, Telli ML. Neoadjuvant Talazoparib in Patients With Germline BRCA1/2 Mutation-Positive, Early-Stage Triple-Negative Breast Cancer: Results of a Phase II Study. Oncologist 2023; 28:845-855. [PMID: 37318349 PMCID: PMC10546823 DOI: 10.1093/oncolo/oyad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/14/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The undetermined efficacy of the current standard-of-care neoadjuvant treatment, anthracycline/platinum-based chemotherapy, in patients with early-stage triple-negative breast cancer (TNBC) and germline BRCA mutations emphasizes the need for biomarker-targeted treatment, such as poly(ADP-ribose) polymerase inhibitors, in this setting. This phase II, single-arm, open-label study evaluated the efficacy and safety of neoadjuvant talazoparib in patients with germline BRCA1/2-mutated early-stage TNBC. PATIENTS AND METHODS Patients with germline BRCA1/2-mutated early-stage TNBC received talazoparib 1 mg once daily for 24 weeks (0.75 mg for moderate renal impairment) followed by surgery. The primary endpoint was pathologic complete response (pCR) by independent central review (ICR). Secondary endpoints included residual cancer burden (RCB) by ICR. Safety and tolerability of talazoparib and patient-reported outcomes were assessed. RESULTS Of 61 patients, 48 received ≥80% talazoparib doses, underwent surgery, and were assessed for pCR or progressed before pCR assessment and considered nonresponders. pCR rate was 45.8% (95% confidence interval [CI], 32.0%-60.6%) and 49.2% (95% CI, 36.7%-61.6%) in the evaluable and intent-to-treat (ITT) population, respectively. RCB 0/I rate was 45.8% (95% CI, 29.4%-63.2%) and 50.8% (95% CI, 35.5%-66.0%) in the evaluable and ITT population, respectively. Treatment-related adverse events (TRAE) were reported in 58 (95.1%) patients. Most common grade 3 and 4 TRAEs were anemia (39.3%) and neutropenia (9.8%). There was no clinically meaningful detriment in quality of life. No deaths occurred during the reporting period; 2 deaths due to progressive disease occurred during long-term follow-up (>400 days after first dose). CONCLUSIONS Neoadjuvant talazoparib monotherapy was active despite pCR rates not meeting the prespecified threshold; these rates were comparable to those observed with combination anthracycline- and taxane-based chemotherapy regimens. Talazoparib was generally well tolerated. CLINICALTRIALS.GOV IDENTIFIER NCT03499353.
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Affiliation(s)
- Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Thaddeus Beck
- Department of Medical Oncology and Hematology, Highlands Oncology, Springdale, AR, USA
| | - Jason M Jones
- Avera Medical Group Oncology & Hematology, Avera Cancer Institute, Sioux Falls, SD, USA
| | - Jay Andersen
- Medical Oncology, Compass Oncology, West Cancer Center, US Oncology Network, Tigard, OR, USA
| | - Joanne L Blum
- Department of Oncology, Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas, TX, USA
| | - Lida A Mina
- Hematology Oncology Department, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Raymond Brig
- Medical Oncology, Brig Center for Cancer Care and Survivorship, Knoxville, TN, USA
| | - Michael Danso
- Medical Oncology, Virginia Oncology Associates, Norfolk, VA, USA
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, Cedars-Sinai Cancer Center, West Hollywood, CA, USA
| | | | - Kay Noonan
- Clinical Oncology, Pfizer Inc., Groton, CT, USA
| | | | | | - Akos Czibere
- Oncology Drug Development, Pfizer Inc., Cambridge, MA, USA
| | - William F Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melinda L Telli
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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6
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Xu Z, Rauch DE, Mohamed RM, Pashapoor S, Zhou Z, Panthi B, Son JB, Hwang KP, Musall BC, Adrada BE, Candelaria RP, Leung JWT, Le-Petross HTC, Lane DL, Perez F, White J, Clayborn A, Reed B, Chen H, Sun J, Wei P, Thompson A, Korkut A, Huo L, Hunt KK, Litton JK, Valero V, Tripathy D, Yang W, Yam C, Ma J. Deep Learning for Fully Automatic Tumor Segmentation on Serially Acquired Dynamic Contrast-Enhanced MRI Images of Triple-Negative Breast Cancer. Cancers (Basel) 2023; 15:4829. [PMID: 37835523 PMCID: PMC10571741 DOI: 10.3390/cancers15194829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Accurate tumor segmentation is required for quantitative image analyses, which are increasingly used for evaluation of tumors. We developed a fully automated and high-performance segmentation model of triple-negative breast cancer using a self-configurable deep learning framework and a large set of dynamic contrast-enhanced MRI images acquired serially over the patients' treatment course. Among all models, the top-performing one that was trained with the images across different time points of a treatment course yielded a Dice similarity coefficient of 93% and a sensitivity of 96% on baseline images. The top-performing model also produced accurate tumor size measurements, which is valuable for practical clinical applications.
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Affiliation(s)
- Zhan Xu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - David E. Rauch
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Rania M. Mohamed
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanaz Pashapoor
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zijian Zhou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Bikash Panthi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Benjamin C. Musall
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
| | - Beatriz E. Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rosalind P. Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jessica W. T. Leung
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Huong T. C. Le-Petross
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Deanna L. Lane
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frances Perez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jason White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alyson Clayborn
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Brandy Reed
- Department of Clinical Research Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Huiqin Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alastair Thompson
- Section of Breast Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Anil Korkut
- Department of Bioinformatics & Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wei Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Z.X.)
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7
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Akkoc Mustafayev FN, Liu DD, Gutierrez AM, Lewis JE, Ibrahim NK, Valero V, Booser DJ, Litton JK, Koenig K, Yu D, Sneige N, Arun BK. Short-Term Biomarker Modulation Study of Dasatinib for Estrogen Receptor-Negative Breast Cancer Chemoprevention. Eur J Breast Health 2023; 19:267-273. [PMID: 37795002 PMCID: PMC10546803 DOI: 10.4274/ejbh.galenos.2023.2023-7-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/26/2023] [Indexed: 10/06/2023]
Abstract
Objective Risk-reducing therapy with selective estrogen receptor (ER) modulators and aromatase inhibitors reduce breast cancer risk. However, the effects are limited to ER-positive breast cancer. Therefore, new agents with improved toxicity profiles that reduce the risk in ER-negative breast cancers are urgently needed. The aim of this prospective, short-term, prevention study was to evaluate the effect of dasatinib, an inhibitor of the tyrosine kinase Src, on biomarkers in normal (but increased risk) breast tissue and serum of women at high risk for a second, contralateral primary breast cancer. Materials and Methods Women with a history of unilateral stage I, II, or III ER-negative breast cancer, having no active disease, and who completed all adjuvant therapies were eligible. Patients underwent baseline fine-needle aspiration (FNA) of the contralateral breast and serum collection for biomarker analysis and were randomized to receive either no treatment (control) or dasatinib at 40 or 80 mg/day for three months. After three months, serum collection and breast FNA were repeated. Planned biomarker analysis consisted of changes in cytology and Ki-67 on breast FNA, and changes in serum levels of insulin-like growth factor 1 (IGF-1), IGF-binding protein 1, and IGF-binding protein 3. The primary objective was to evaluate changes in Ki-67 and secondary objective included changes in cytology in breast tissue and IGF-related serum biomarkers. Toxicity was also evaluated. Results Twenty-three patients started their assigned treatments. Compliance during the study was high, with 86.9% (20/23) of patients completing their assigned doses. Dasatinib was well tolerated and no drug-related grade 3 and 4 adverse events were observed. Since only one patient met the adequacy criteria for the paired FNA sample, we could not evaluate Ki-67 level or cytological changes. No significant change in serum biomarkers was observed among the three groups. Conclusion Dasatinib was well tolerated but did not induce any significant changes in serum biomarkers. The study could not fulfill its primary objective due to an inadequate number of paired FNA samples. Further, larger studies are needed to evaluate the effectiveness of Src inhibitors in breast cancer prevention.
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Affiliation(s)
| | - Diane D. Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Angelica M. Gutierrez
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - John E. Lewis
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Nuhad K. Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Daniel J. Booser
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Kimberly Koenig
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Dihua Yu
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Nour Sneige
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Banu K. Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
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8
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Litton JK, Regan MM, Pusztai L, Rugo HS, Tolaney SM, Garrett-Mayer E, Amiri-Kordestani L, Basho RK, Best AF, Boileau JF, Denkert C, Foster JC, Harbeck N, Jacene HA, King TA, Mason G, O'Sullivan CC, Prowell TM, Richardson AL, Sepulveda KA, Smith ML, Tjoe JA, Turashvili G, Woodward WA, Butler LP, Schwartz EI, Korde LA. Standardized Definitions for Efficacy End Points in Neoadjuvant Breast Cancer Clinical Trials: NeoSTEEP. J Clin Oncol 2023; 41:4433-4442. [PMID: 37433103 PMCID: PMC10522109 DOI: 10.1200/jco.23.00435] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/25/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
PURPOSE The Standardized Definitions for Efficacy End Points (STEEP) criteria, established in 2007 and updated in 2021 (STEEP 2.0), provide standardized definitions of adjuvant breast cancer (BC) end points. STEEP 2.0 identified a need to separately address end points for neoadjuvant clinical trials. The multidisciplinary NeoSTEEP working group of experts was convened to critically evaluate and align neoadjuvant BC trial end points. METHODS The NeoSTEEP working group concentrated on neoadjuvant systemic therapy end points in clinical trials with efficacy outcomes-both pathologic and time-to-event survival end points-particularly for registrational intent. Special considerations for subtypes and therapeutic approaches, imaging, nodal staging at surgery, bilateral and multifocal diseases, correlative tissue collection, and US Food and Drug Administration regulatory considerations were contemplated. RESULTS The working group recommends a preferred definition of pathologic complete response (pCR) as the absence of residual invasive cancer in the complete resected breast specimen and all sampled regional lymph nodes (ypT0/Tis ypN0 per AJCC staging). Residual cancer burden should be a secondary end point to facilitate future assessment of its utility. Alternative end points are needed for hormone receptor-positive disease. Time-to-event survival end point definitions should pay particular attention to the measurement starting point. Trials should include end points originating at random assignment (event-free survival and overall survival) to capture presurgery progression and deaths as events. Secondary end points adapted from STEEP 2.0, which are defined from starting at curative-intent surgery, may also be appropriate. Specification and standardization of biopsy protocols, imaging, and pathologic nodal evaluation are also crucial. CONCLUSION End points in addition to pCR should be selected on the basis of clinical and biologic aspects of the tumor and the therapeutic agent investigated. Consistent prespecified definitions and interventions are paramount for clinically meaningful trial results and cross-trial comparison.
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Affiliation(s)
- Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Meredith M. Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Lajos Pusztai
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Hope S. Rugo
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Sara M. Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Reva K. Basho
- The Lawrence J. Ellison Institute for Transformative Medicine, Los Angeles, CA
| | - Ana F. Best
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
| | | | - Carsten Denkert
- Institute of Pathology, Philipps University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - Jared C. Foster
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
| | - Nadia Harbeck
- The Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
| | | | - Tari A. King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Ginny Mason
- The Inflammatory Breast Cancer Research Foundation, Broadway, VA
| | | | - Tatiana M. Prowell
- US Food and Drug Administration, Silver Spring, MD
- Women's Malignancies Disease Group, Johns Hopkins Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | - Judy A. Tjoe
- Division of Breast Surgery, Department of Surgery, Novant Health, Greensboro, NC
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA
| | - Wendy A. Woodward
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Elena I. Schwartz
- Coordinating Center for Clinical Trials, National Cancer Institute, Rockville, MD
| | - Larissa A. Korde
- Cancer Therapy and Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
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9
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Chen H, Ding Q, Khazai L, Zhao L, Damodaran S, Litton JK, Rauch GM, Yam C, Chang JT, Seth S, Lim B, Thompson AM, Mittendorf EA, Adrada B, Virani K, White JB, Ravenberg E, Song X, Candelaria R, Arun B, Ueno NT, Santiago L, Saleem S, Abouharb S, Murthy RK, Ibrahim N, Routbort MJ, Sahin A, Valero V, Symmans WF, Tripathy D, Wang WL, Moulder S, Huo L. PTEN in triple-negative breast carcinoma: protein expression and genomic alteration in pretreatment and posttreatment specimens. Ther Adv Med Oncol 2023; 15:17588359231189422. [PMID: 37547448 PMCID: PMC10399250 DOI: 10.1177/17588359231189422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Recent advances have been made in targeting the phosphoinositide 3-kinase pathway in breast cancer. Phosphatase and tensin homolog (PTEN) is a key component of that pathway. Objective To understand the changes in PTEN expression over the course of the disease in patients with triple-negative breast cancer (TNBC) and whether PTEN copy number variation (CNV) by next-generation sequencing (NGS) can serve as an alternative to immunohistochemistry (IHC) to identify PTEN loss. Methods We compared PTEN expression by IHC between pretreatment tumors and residual tumors in the breast and lymph nodes after neoadjuvant chemotherapy in 96 patients enrolled in a TNBC clinical trial. A correlative analysis between PTEN protein expression and PTEN CNV by NGS was also performed. Results With a stringent cutoff for PTEN IHC scoring, PTEN expression was discordant between pretreatment and posttreatment primary tumors in 5% of patients (n = 96) and between posttreatment primary tumors and lymph node metastases in 9% (n = 33). A less stringent cutoff yielded similar discordance rates. Intratumoral heterogeneity for PTEN loss was observed in 7% of the patients. Among pretreatment tumors, PTEN copy numbers by whole exome sequencing (n = 72) were significantly higher in the PTEN-positive tumors by IHC compared with the IHC PTEN-loss tumors (p < 0.0001). However, PTEN-positive and PTEN-loss tumors by IHC overlapped in copy numbers: 14 of 60 PTEN-positive samples showed decreased copy numbers in the range of those of the PTEN-loss tumors. Conclusion Testing various specimens by IHC may generate different PTEN results in a small proportion of patients with TNBC; therefore, the decision of testing one versus multiple specimens in a clinical trial should be defined in the patient inclusion criteria. Although a distinct cutoff by which CNV differentiated PTEN-positive tumors from those with PTEN loss was not identified, higher copy number of PTEN may confer positive PTEN, whereas lower copy number of PTEN would necessitate additional testing by IHC to assess PTEN loss. Trial registration NCT02276443.
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Affiliation(s)
- Hui Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laila Khazai
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Li Zhao
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gaiane M. Rauch
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey T. Chang
- Department of Integrative Biology and Pharmacology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sahil Seth
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bora Lim
- Department of Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Alastair M. Thompson
- Division of Surgical Oncology, Section of Breast Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Elizabeth A. Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Beatriz Adrada
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kiran Virani
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason B. White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xingzhi Song
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosalind Candelaria
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T. Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lumarie Santiago
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sadia Saleem
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sausan Abouharb
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rashmi K. Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nuhad Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Aysegul Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stacy Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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10
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Zhou Z, Adrada BE, Candelaria RP, Elshafeey NA, Boge M, Mohamed RM, Pashapoor S, Sun J, Xu Z, Panthi B, Son JB, Guirguis MS, Patel MM, Whitman GJ, Moseley TW, Scoggins ME, White JB, Litton JK, Valero V, Hunt KK, Tripathy D, Yang W, Wei P, Yam C, Pagel MD, Rauch GM, Ma J. Predicting pathological complete response to neoadjuvant systemic therapy for triple-negative breast cancers using deep learning on multiparametric MRIs. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083160 DOI: 10.1109/embc40787.2023.10340987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
We trained and validated a deep learning model that can predict the treatment response to neoadjuvant systemic therapy (NAST) for patients with triple negative breast cancer (TNBC). Dynamic contrast enhanced (DCE) MRI and diffusion-weighted imaging (DWI) of the pre-treatment (baseline) and after four cycles (C4) of doxorubicin/cyclophosphamide treatment were used as inputs to the model for prediction of pathologic complete response (pCR). Based on the standard pCR definition that includes disease status in either breast or axilla, the model achieved areas under the receiver operating characteristic curves (AUCs) of 0.96 ± 0.05, 0.78 ± 0.09, 0.88 ± 0.02, and 0.76 ± 0.03, for the training, validation, testing, and prospective testing groups, respectively. For the pCR status of breast only, the retrained model achieved prediction AUCs of 0.97 ± 0.04, 0.82 ± 0.10, 0.86 ± 0.03, and 0.83 ± 0.02, for the training, validation, testing, and prospective testing groups, respectively. Thus, the developed deep learning model is highly promising for predicting the treatment response to NAST of TNBC.Clinical Relevance- Deep learning based on serial and multiparametric MRIs can potentially distinguish TNBC patients with pCR from non-pCR at the early stage of neoadjuvant systemic therapy, potentially enabling more personalized treatment of TNBC patients.
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11
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Hwang KP, Elshafeey NA, Kotrotsou A, Chen H, Son JB, Boge M, Mohamed RM, Abdelhafez AH, Adrada BE, Panthi B, Sun J, Musall BC, Zhang S, Candelaria RP, White JB, Ravenberg EE, Tripathy D, Yam C, Litton JK, Huo L, Thompson AM, Wei P, Yang WT, Pagel MD, Ma J, Rauch GM. A Radiomics Model Based on Synthetic MRI Acquisition for Predicting Neoadjuvant Systemic Treatment Response in Triple-Negative Breast Cancer. Radiol Imaging Cancer 2023; 5:e230009. [PMID: 37505106 PMCID: PMC10413296 DOI: 10.1148/rycan.230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/18/2023] [Accepted: 06/03/2023] [Indexed: 07/29/2023]
Abstract
Purpose To determine if a radiomics model based on quantitative maps acquired with synthetic MRI (SyMRI) is useful for predicting neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC). Materials and Methods In this prospective study, 181 women diagnosed with stage I-III TNBC were scanned with a SyMRI sequence at baseline and at midtreatment (after four cycles of NAST), producing T1, T2, and proton density (PD) maps. Histopathologic analysis at surgery was used to determine pathologic complete response (pCR) or non-pCR status. From three-dimensional tumor contours drawn on the three maps, 310 histogram and textural features were extracted, resulting in 930 features per scan. Radiomic features were compared between pCR and non-pCR groups by using Wilcoxon rank sum test. To build a multivariable predictive model, logistic regression with elastic net regularization and cross-validation was performed for texture feature selection using 119 participants (median age, 52 years [range, 26-77 years]). An independent testing cohort of 62 participants (median age, 48 years [range, 23-74 years]) was used to evaluate and compare the models by area under the receiver operating characteristic curve (AUC). Results Univariable analysis identified 15 T1, 10 T2, and 12 PD radiomic features at midtreatment that predicted pCR with an AUC greater than 0.70 in both the training and testing cohorts. Multivariable radiomics models of maps acquired at midtreatment demonstrated superior performance over those acquired at baseline, achieving AUCs as high as 0.78 and 0.72 in the training and testing cohorts, respectively. Conclusion SyMRI-based radiomic features acquired at midtreatment are potentially useful for identifying early NAST responders in TNBC. Keywords: MR Imaging, Breast, Outcomes Analysis ClinicalTrials.gov registration no. NCT02276443 Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Houser and Rapelyea in this issue.
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Affiliation(s)
- Ken-Pin Hwang
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Nabil A. Elshafeey
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Aikaterini Kotrotsou
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Huiqin Chen
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Jong Bum Son
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Medine Boge
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Rania M. Mohamed
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Abeer H. Abdelhafez
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Beatriz E. Adrada
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Bikash Panthi
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Jia Sun
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Benjamin C. Musall
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Shu Zhang
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Rosalind P. Candelaria
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Jason B. White
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Elizabeth E. Ravenberg
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Debu Tripathy
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Clinton Yam
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Jennifer K. Litton
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Lei Huo
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Alastair M. Thompson
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Peng Wei
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Wei T. Yang
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Mark D. Pagel
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Jingfei Ma
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
| | - Gaiane M. Rauch
- From the Departments of Imaging Physics (K.P.H., A.K., J.B.S., B.P.,
B.C.M., J.M.), Breast Imaging (N.A.E., M.B., R.M.M., A.H.A., B.E.A., R.P.C.,
W.T.Y., G.M.R.), Biostatistics (H.C., J.S., P.W.), Cancer Systems Imaging (S.Z.,
M.D.P.), Moon Shots Operations (J.B.W.), Breast Medical Oncology (E.E.R., D.T.,
C.Y.), Clinical Research (J.K.L.), Pathology (L.H.), and Abdominal Imaging
(G.M.R.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030; and Division of Surgical Oncology, Baylor College of
Medicine, Houston, Tex (A.M.T.)
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12
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Abuhadra N, Sun R, Yam C, Rauch GM, Ding Q, Lim B, Thompson AM, Mittendorf EA, Adrada BE, Damodaran S, Virani K, White J, Ravenberg E, Sun J, Choi J, Candelaria R, Arun B, Ueno NT, Santiago L, Saleem S, Abouharb S, Murthy RK, Ibrahim N, Sahin A, Valero V, Symmans WF, Litton JK, Tripathy D, Moulder S, Huo L. Predictive Roles of Baseline Stromal Tumor-Infiltrating Lymphocytes and Ki-67 in Pathologic Complete Response in an Early-Stage Triple-Negative Breast Cancer Prospective Trial. Cancers (Basel) 2023; 15:3275. [PMID: 37444385 DOI: 10.3390/cancers15133275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
High stromal tumor-infiltrating lymphocytes (sTILs) are associated with improved pathologic complete response (pCR) in triple-negative breast cancer (TNBC). We hypothesize that integrating high sTILs and additional clinicopathologic features associated with pCR could enhance our ability to predict the group of patients on whom treatment de-escalation strategies could be tested. In this prospective early-stage TNBC neoadjuvant chemotherapy study, pretreatment biopsies from 408 patients were evaluated for their clinical and demographic features, as well as biomarkers including sTILs, Ki-67, PD-L1 and androgen receptor. Multivariate logistic regression models were developed to generate a computed response score to predict pCR. The pCR rate for the entire cohort was 41%. Recursive partitioning analysis identified ≥20% as the optimal cutoff for sTILs to denote 35% (143/408) of patients as having high sTILs, with a pCR rate of 59%, and 65% (265/408) of patients as having low sTILs, with a pCR rate of 31%. High Ki-67 (cutoff > 35%) was identified as the only predictor of pCR in addition to sTILs in the training set. This finding was verified in the testing set, where the highest computed response score encompassing both high sTILa and high Ki-67 predicted a pCR rate of 65%. Integrating Ki67 and sTIL may refine the selection of early stage TNBC patients for neoadjuvant clinical trials evaluating de-escalation strategies.
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Affiliation(s)
- Nour Abuhadra
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gaiane M Rauch
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bora Lim
- Department of Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Alastair M Thompson
- Division of Surgical Oncology, Section of Breast Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Beatriz E Adrada
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kiran Virani
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jason White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elizabeth Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jaihee Choi
- Department of Statistics, Rice University, Houston, TX 77005, USA
| | - Rosalind Candelaria
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lumarie Santiago
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sadia Saleem
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sausan Abouharb
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rashmi K Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nuhad Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aysegul Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - William Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Stacy Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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13
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Yam C, Mittendorf EA, Garber HR, Sun R, Damodaran S, Murthy RK, Ramirez D, Karuturi M, Layman RM, Ibrahim N, Rauch GM, Adrada BE, Candelaria RP, White JB, Ravenberg E, Clayborn A, Ding QQ, Symmans WF, Prabhakaran S, Thompson AM, Valero V, Tripathy D, Huo L, Moulder SL, Litton JK. A phase II study of neoadjuvant atezolizumab and nab-paclitaxel in patients with anthracycline-resistant early-stage triple-negative breast cancer. Breast Cancer Res Treat 2023; 199:457-469. [PMID: 37061619 DOI: 10.1007/s10549-023-06929-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/30/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE Neoadjuvant anti-PD-(L)1 therapy improves the pathological complete response (pCR) rate in unselected triple-negative breast cancer (TNBC). Given the potential for long-term morbidity from immune-related adverse events (irAEs), optimizing the risk-benefit ratio for these agents in the curative neoadjuvant setting is important. Suboptimal clinical response to initial neoadjuvant therapy (NAT) is associated with low rates of pCR (2-5%) and may define a patient selection strategy for neoadjuvant immune checkpoint blockade. We conducted a single-arm phase II study of atezolizumab and nab-paclitaxel as the second phase of NAT in patients with doxorubicin and cyclophosphamide (AC)-resistant TNBC (NCT02530489). METHODS Patients with stage I-III, AC-resistant TNBC, defined as disease progression or a < 80% reduction in tumor volume after 4 cycles of AC, were eligible. Patients received atezolizumab (1200 mg IV, Q3weeks × 4) and nab-paclitaxel (100 mg/m2 IV,Q1 week × 12) as the second phase of NAT before undergoing surgery followed by adjuvant atezolizumab (1200 mg IV, Q3 weeks, × 4). A two-stage Gehan-type design was employed to detect an improvement in pCR/residual cancer burden class I (RCB-I) rate from 5 to 20%. RESULTS From 2/15/2016 through 1/29/2021, 37 patients with AC-resistant TNBC were enrolled. The pCR/RCB-I rate was 46%. No new safety signals were observed. Seven patients (19%) discontinued atezolizumab due to irAEs. CONCLUSION This study met its primary endpoint, demonstrating a promising signal of activity in this high-risk population (pCR/RCB-I = 46% vs 5% in historical controls), suggesting that a response-adapted approach to the utilization of neoadjuvant immunotherapy should be considered for further evaluation in a randomized clinical trial.
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Affiliation(s)
- Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA.
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Haven R Garber
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Ryan Sun
- Department of Biostatistics, Division of Basic Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Rashmi K Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - David Ramirez
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Meghan Karuturi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Rachel M Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Nuhad Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Gaiane M Rauch
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beatriz E Adrada
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosalind P Candelaria
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Elizabeth Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Alyson Clayborn
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Qing Qing Ding
- Department of Pathology, Division of Pathology-Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Fraser Symmans
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sabitha Prabhakaran
- Department of Genomic Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alastair M Thompson
- Section of Breast Surgery, Division of Surgical Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Lei Huo
- Department of Pathology, Division of Pathology-Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stacy L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB5.3542), 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA.
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Abuhadra N, Sun R, Bassett RL, Huo L, Chang JT, Teshome M, Clayborn AR, White JB, Ravenberg EE, Adrada BE, Candelaria RP, Yang W, Ding Q, Symmans WF, Arun B, Damodaran S, Koenig KB, Layman RM, Lim B, Litton JK, Thompson A, Ueno NT, Piwnica-Worms H, Hortobagyi GN, Valero V, Tripathy D, Rauch GM, Moulder S, Yam C. Targeting chemotherapy resistance in mesenchymal triple-negative breast cancer: a phase II trial of neoadjuvant angiogenic and mTOR inhibition with chemotherapy. Invest New Drugs 2023:10.1007/s10637-023-01357-4. [PMID: 37043123 DOI: 10.1007/s10637-023-01357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Nour Abuhadra
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey T Chang
- Department of Integrative Biology and Pharmacology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alyson R Clayborn
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Elizabeth E Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Beatriz E Adrada
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosalind P Candelaria
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Yang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Kimberly B Koenig
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Rachel M Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Alastair Thompson
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Helen Piwnica-Worms
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Gaiane M Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stacy Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Damodaran S, Liu D, Schwartz J, Valero V, Ramirez D, Saleem S, Ueno NT, Ibrahim NK, Karuturi MS, Murthy RK, Moulder S, Litton JK. Abstract P3-02-03: A phase Ib trial of bintrafusp alfa and eribulin in patients with metastatic triple negative breast cancer (TNBC). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Metastatic TNBC is an aggressive breast cancer subtype with poor prognosis and limited systemic therapy options. While pembrolizumab in combination with chemotherapy is approved for PD-L1 positive TNBC, limited immunotherapy options exist for patients with progressive and/or PD-L1 negative disease. TGFβ released by cancer cells and stromal fibroblasts attenuates the intrinsic antitumor potential of immune cells within the tumor microenvironment mediating resistance to immunotherapy. Consequently, inhibition of TGFβ signaling could potentially enhance antitumor responses to anti-PD-L1/PD-1 therapies. Bintrafusp alfa is a bifunctional fusion protein composed of the extracellular domain of TGF-β receptor II (a TGF-β “trap”) fused to a human IgG1 monoclonal antibody blocking programmed cell death ligand 1. Preclinical studies have shown that eribulin downregulates TGFβ by phosphorylation of Smad proteins. Therefore, combining eribulin with bintrafusp alfa may have a synergistic effect. This study evaluated the combination of bintrafusp alfa with eribulin in patients with metastatic TNBC. Methods: This is a phase 1b, open label, single center study evaluating bintrafusp alfa in combination with eribulin in patients with metastatic TNBC who had relapsed/progressed on prior therapies. Patients with ER/PR ≤10% with measurable disease were enrolled. Patients who received prior anti-PD-1/PD-L1 therapies in the metastatic setting were excluded. Patients received bintrafusp alfa 1200 mg intravenously every 2 weeks in combination with eribulin (1.4 mg/m2 (dose level 1), 1.1 mg/m2, or 0.7 mg/m2) on days 1, 8, 22, 29 on every 6-week cycle. Primary objectives were to determine the recommended phase II dose (RP2D) as well as to evaluate the safety and tolerability of eribulin in combination with the fixed dose of bintrafusp alfa. Secondary objective was to determine the overall response rate (ORR) according to RECIST 1.1. Bayesian optimal interval (BOIN) design was employed to identify the RP2D. Toxicities assessed using CTCAE v4.03. Tumor assessments were performed every 6 weeks. Results: A total of 25 patients were enrolled on the study. Twenty-one patients were evaluable (3 screen failures, 1 received only one dose of study treatment). Median age 59 (range 27-85). Median number of prior therapies 2 (range 0-8). The most common reason for protocol discontinuation was disease progression (n = 15, 71%). Four patients experienced dose limiting toxicities (DLTs); 3 with decreased neutrophil count and 1 with increased aspartate aminotransferase. Five patients (24%) experienced grade 4 toxicities (increased aspartate aminotransferase, hypokalemia, hypophosphatemia, neutropenia). Nine patients (43%) experienced grade 3 toxicities. Three patients (14%) discontinued study due to toxicity. Total of 2 deaths were observed, none related to treatment. Most common toxicities (any grade) include anemia (n = 13 patients), elevated aspartate aminotransferase (11), neutropenia (n = 10), elevated aminotransferase (9), headache (n = 9), hypokalemia (n = 8), hyperglycemia (n = 8), leukopenia (n = 8), and fatigue (n = 8). RP2D was eribulin 1.1 mg/m2 with bintrafusp alfa 1200 mg. Six patients had PR (28.6%), 2 had SD (9.5%) and 12 had PD (57.1%) as the best response. One patient withdrew before response evaluation. Median PFS was 1.7 months (95% CI: (1.2, 5.9) and median OS was 11.1 months (95%CI: (5.2, 15.7). Conclusions: The combination of bintrafusp alfa with eribulin has manageable safety profile with meaningful clinical activity in patients with TNBC. Further studies evaluating TGF inhibitors in breast cancer are warranted.
Citation Format: Senthil Damodaran, Diane Liu, Jill Schwartz, Vicente Valero, David Ramirez, Sadia Saleem, Naoto T. Ueno, Nuhad K. Ibrahim, Meghan S. Karuturi, Rashmi K. Murthy, Stacy Moulder, Jennifer K. Litton. A phase Ib trial of bintrafusp alfa and eribulin in patients with metastatic triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-02-03.
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Affiliation(s)
| | | | | | - Vicente Valero
- 4Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Naoto T. Ueno
- 7The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Rashmi K. Murthy
- 10The University of Texas MD Anderson Cancer Center, Houston, Texas
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Mohamed RM, Panthi B, Adrada B, Candelaria R, Guirguis MS, Yang W, Boge M, Patel M, Elshafeey N, Pashapoor S, Zhou Z, Son JB, Hwang KP, Le-Petross HTC, Leung J, Scoggins ME, Whitman GJ, Xu Z, Lane DL, Moseley T, Perez F, White J, Ravenberg E, Clayborn A, Pagel M, Chen H, Sun J, Wei P, Thompson AM, Moulder S, Korkut A, Huo L, Hunt KK, Litton JK, Valero V, Tripathy D, Yam C, Ma J, Rauch G. Abstract P6-01-06: Multi-Parametric MRI-Based Radiomics Models from Tumor and Peritumoral Regions as Potential Predictors of Treatment Response to Neoadjuvant Systemic Therapy in Triple Negative Breast Cancer Patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-01-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
PURPOSE Triple negative breast cancer (TNBC) is an aggressive and heterogeneous subtype of breast cancer. Pathologic complete response (pCR) to neoadjuvant systemic therapy (NAST) predicts better survival. Early prediction of the treatment response can potentially triage non-responding patients to alternative protocol treatments, spare them of the unneeded toxicity, and improve pCR. We evaluated the ability of radiomic textural analysis of intratumoral and peritumoral regions on the dynamic contrast enhanced (DCE) and diffusion-weighted imaging (DWI) MRI images obtained early during NAST to predict pCR. MATERIALS AND METHODS This IRB-approved prospective study (NCT02276443) included 182 patients with biopsy proven stage I-III TNBC who had multiparametric MRIs at baseline (BL), post 2 cycles (C2), and post 4 cycles (C4) of NAST before surgery. Tumors and peritumoral regions of 5 mm and 10 mm in thickness were segmented on the 2.5 minutes DCE subtraction images and on the b=800 DWI images. Ten histogram-based first order texture features including mean, minimum, maximum, standard deviation, kurtosis, skewness, 1st, 5th, 95th, and 99th percentile, and 300 radiomic Grey Level Co-occurrence matrix (GLCM) features along with their absolute and relative differences between the 3 imaging time points were extracted from the tumors and from the peritumoral regions with an in-house Matlab toolbox. Treatment response at surgery (pCR vs non-pCR) was documented. The samples were divided into training and testing datasets by a 2:1 ratio. Area under the receiver operating characteristics curve (AUC ROC) was calculated for univariate analysis in predicting pCR. Logistic regression with elastic net regularization was performed for texture feature selection. Parameter optimization was performed by using 5-fold cross-validation based on mean cross-validated AUC in the training set. RESULTS Of 182 TNBC patients, 88 (48%) had pCR and 94 (52%) did not achieve pCR. Eight multivariate models combining radiomic features from both DCE and DWI tumoral and peritumoral regions had AUC > 0.8 (0.807-0.831) with p-value < 0.001 in both training and testing sets. The highest AUC=0.831 was obtained from a model consisting of 15 radiomic features: tumor DWI (5 GLCM features) at C2, peritumoral region on DCE (skewness) at C2, tumor DCE (1st, 5th percentile) at C4, tumor DWI (3 GLCM features) at C4, peritumoral region DWI (1 GLCM feature) at C4, and the relative difference between C4/C2 on DCE (5th, 95th percentile and mean). CONCLUSION Multi-parametric MRI-based radiomics models from the tumor and the peritumoral regions showed high accuracy as potential early predictors of NAST response in TNBC patients.
Citation Format: Rania M. Mohamed, Bikash Panthi, Beatriz Adrada, Rosalind Candelaria, Mary S. Guirguis, Wei Yang, Medine Boge, Miral Patel, Nabil Elshafeey, Sanaz Pashapoor, Zijian Zhou, Jong Bum Son, Ken-Pin Hwang, H. T. Carisa Le-Petross, Jessica Leung, Marion E. Scoggins, Gary J. Whitman, Zhan Xu, Deanna L. Lane, Tanya Moseley, Frances Perez, Jason White, Elizabeth Ravenberg, Alyson Clayborn, Mark Pagel, Huiqin Chen, Jia Sun, Peng Wei, Alastair M. Thompson, Stacy Moulder, Anil Korkut, Lei Huo, Kelly K. Hunt, Jennifer K. Litton, Vicente Valero, Debu Tripathy, Clinton Yam, Jingfei Ma, Gaiane Rauch. Multi-Parametric MRI-Based Radiomics Models from Tumor and Peritumoral Regions as Potential Predictors of Treatment Response to Neoadjuvant Systemic Therapy in Triple Negative Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-01-06.
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Affiliation(s)
- Rania M. Mohamed
- 1The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Beatriz Adrada
- 3University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Wei Yang
- 6Department of Breast Imaging - University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Medine Boge
- 7The University of Texas MD Anderson Cancer Center
| | - Miral Patel
- 8University of Texas MD Anderson Cancer Center
| | | | - Sanaz Pashapoor
- 10University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zijian Zhou
- 11The University of Texas MD Anderson Cancer Center
| | | | | | | | | | | | - Gary J. Whitman
- 17The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhan Xu
- 18MD Anderson Cancer Center, Texas
| | | | | | | | - Jason White
- 22The University of Texas MD Anderson Cancer Center
| | | | | | - Mark Pagel
- 25The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Huiqin Chen
- 26The University of Texas MD Anderson Cancer Center
| | - Jia Sun
- 27The University of Texas MD Anderson Cancer Center
| | - Peng Wei
- 28The University of Texas MD Anderson Cancer Center
| | | | | | - Anil Korkut
- 31The University of Texas MD Anderson Cancer Center
| | - Lei Huo
- 32The University of Texas MD Anderson Cancer Center
| | - Kelly K. Hunt
- 33The University of Texas MD Anderson Cancer Center, Texas
| | | | - Vicente Valero
- 35Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center,, Houston
| | - Debu Tripathy
- 36The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clinton Yam
- 37Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center
| | - Jingfei Ma
- 38University of Texas MD Anderson Cancer Center
| | - Gaiane Rauch
- 39The University of Texas MD Anderson Cancer Center
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Postel-Vinay S, Lam VK, Ros W, Bauer TM, Hansen AR, Cho DC, Stephen Hodi F, Schellens JHM, Litton JK, Aspeslagh S, Autio KA, Opdam FL, McKean M, Somaiah N, Champiat S, Altan M, Spreafico A, Rahma O, Paul EM, Ahlers CM, Zhou H, Struemper H, Gorman SA, Watmuff M, Yablonski KM, Yanamandra N, Chisamore MJ, Schmidt EV, Hoos A, Marabelle A, Weber JS, Heymach JV. First-in-human phase I study of the OX40 agonist GSK3174998 with or without pembrolizumab in patients with selected advanced solid tumors (ENGAGE-1). J Immunother Cancer 2023; 11:jitc-2022-005301. [PMID: 36927527 PMCID: PMC10030671 DOI: 10.1136/jitc-2022-005301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The phase I first-in-human study ENGAGE-1 evaluated the humanized IgG1 OX40 agonistic monoclonal antibody GSK3174998 alone (Part 1 (P1)) or in combination with pembrolizumab (Part 2 (P2)) in patients with advanced solid tumors. METHODS GSK3174998 (0.003-10 mg/kg) ± pembrolizumab (200 mg) was administered intravenously every 3 weeks using a continuous reassessment method for dose escalation. Primary objectives were safety and tolerability; secondary objectives included pharmacokinetics, immunogenicity, pharmacodynamics, and clinical activity. RESULTS 138 patients were enrolled (45 (P1) and 96 (P2, including 3 crossovers)). Treatment-related adverse events occurred in 51% (P1) and 64% (P2) of patients, fatigue being the most common (11% and 24%, respectively). No dose-toxicity relationship was observed, and maximum-tolerated dose was not reached. Dose-limiting toxicities (P2) included Grade 3 (G3) pleural effusion and G1 myocarditis with G3 increased troponin. GSK3174998 ≥0.3 mg/kg demonstrated pharmacokinetic linearity and >80% receptor occupancy on circulating T cells; 0.3 mg/kg was selected for further evaluation. Limited clinical activity was observed for GSK3174998 (P1: disease control rate (DCR) ≥24 weeks 9%) and was not greater than that expected for pembrolizumab alone (P2: overall response rate 8%, DCR ≥24 weeks 28%). Multiplexed immunofluorescence data from paired biopsies suggested that increased infiltration of natural killer (NK)/natural killer T (NKT) cells and decreased regulatory T cells (Tregs) in the tumor microenvironment may contribute to clinical responses: CD16+CD56-CD134+ NK /NKT cells and CD3+CD4+FOXP3+CD134+ Tregs exhibited the largest magnitude of change on treatment, whereas CD3+CD8+granzyme B+PD-1+CD134+ cytotoxic T cells were the least variable. Tumor gene expression profiling revealed an upregulation of inflammatory responses, T-cell proliferation, and NK cell function on treatment with some inflammatory cytokines upregulated in peripheral blood. However, target engagement, evidenced by pharmacologic activity in peripheral blood and tumor tissue, did not correlate with clinical efficacy. The low number of responses precluded identifying a robust biomarker signature predictive of response. CONCLUSIONS GSK3174998±pembrolizumab was well tolerated over the dose range tested and demonstrated target engagement. Limited clinical activity does not support further development of GSK3174998±pembrolizumab in advanced cancers. TRIAL REGISTRATION NUMBER NCT02528357.
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Affiliation(s)
- Sophie Postel-Vinay
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Vincent K Lam
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Willeke Ros
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Todd M Bauer
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Daniel C Cho
- New York Medical College, Valhalla, New York, USA
| | - F Stephen Hodi
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jan H M Schellens
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jennifer K Litton
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sandrine Aspeslagh
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Karen A Autio
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Frans L Opdam
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Neeta Somaiah
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephane Champiat
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Mehmet Altan
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anna Spreafico
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Osama Rahma
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elaine M Paul
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | - Helen Zhou
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | | | | | | | | | | | | | - Axel Hoos
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Aurelien Marabelle
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Jeffrey S Weber
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - John V Heymach
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Panthi B, Mohamed RM, Adrada B, Candelaria R, Guirguis MS, Yang W, Boge M, Patel M, Elshafeey N, Pashapoor S, Zhou Z, Son JB, Hwang KP, Le-Petross HTC, Leung J, Scoggins ME, Whitman GJ, Xu Z, Lane DL, Moseley T, Perez F, White J, Ravenberg E, Clayborn A, Pagel M, Chen H, Sun J, Wei P, Thompson AM, Moulder S, Korkut A, Huo L, Hunt KK, Litton JK, Valero V, Tripathy D, Yam C, Ma J, Rauch G. Abstract P6-01-34: Longitudinal DCE-MRI Radiomic Models for Early Prediction of Response to Neoadjuvant Systemic Therapy (NAST) in Triple Negative Breast Cancer (TNBC) Patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-01-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background and Purpose Early prediction of neoadjuvant systemic therapy (NAST) response in triple negative breast cancer (TNBC) patients could potentially aid in the selection of alternative therapies and avoid unnecessary toxicity in patients unlikely to achieve pathologic complete response (pCR) with NAST. In this study, we investigated the radiomic features of the peritumoral and the tumoral regions from dynamic contrast enhanced (DCE) MRI acquired at different time points of NAST for early treatment response prediction in TNBC. Methods and Materials This study included 182 biopsy-confirmed stage I-III TNBC patients enrolled in an IRB approved prospective clinical trial (NCT02276433). All patients underwent DCE-MRI on a GE 3T MRI scanner at baseline (BL), after two (C2) and four (C4) cycles of doxorubicin/cyclophosphamide based chemotherapy and before surgery. The peritumoral and the tumoral regions were segmented manually by two fellowship-trained radiologists using early phase (2.5 min) DCE-MRI subtraction images. Ten first order radiomic features, 300 grey-level-co-occurrence matrix (GLCM) features along with their absolute and relative differences (C4/BL, C2/BL, C4/C2) between the 3 imaging time points were extracted from the peritumoral and the tumoral regions. Patients were randomly divided into training and testing sets in a 2:1 ratio. For univariate analysis, area under the receiver operating characteristics curve (AUC ROC) was measured to determine the features most predictive of pCR/non-pCR. Wilcoxon Rank Sum test was used to test the statistical significance of predictive performance. In multivariate analysis, radiomic models were established using logistic regression with elastic net regularization followed by 5-fold cross validation for performance assessment. Results Eighty-eight (48%) patients had pCR (59 training, 29 testing) and 94 (52%) patients had non-pCR (63 training, 31 testing). Twenty-five radiomic features (4 from peritumoral C4, 5 from tumoral C4, 4 from peritumoral C4/BL, 6 from tumoral C4/BL, 2 from peritumoral C4/C2 and 4 from tumoral C4/C2) were statistically significant with AUC ≥ 0.75 in both the training and the testing sets at the univariate analysis. The significant features at C4 had AUCs of 0.75-0.79 for the training set and 0.76-0.81 for the testing set. Changes measured between C4 and BL or C2 showed AUC of 0.76-0.84 in the training and 0.75-0.81 in the testing datasets. Eleven multivariate regression models comprised of radiomic features at BL, C2, C4 and their changes (C4/BL, C4/C2 and C2/BL) showed an AUC of 0.80-0.84 for cross validation and an AUC of 0.80-0.82 for independent testing. Conclusions Radiomic models using longitudinal DCE MRI parameters of peritumoral and tumoral regions during NAST have the potential to predict pCR in TNBC patients undergoing NAST.
Citation Format: Bikash Panthi, Rania M. Mohamed, Beatriz Adrada, Rosalind Candelaria, Mary S. Guirguis, Wei Yang, Medine Boge, Miral Patel, Nabil Elshafeey, Sanaz Pashapoor, Zijian Zhou, Jong Bum Son, Ken-Pin Hwang, H. T. Carisa Le-Petross, Jessica Leung, Marion E. Scoggins, Gary J. Whitman, Zhan Xu, Deanna L. Lane, Tanya Moseley, Frances Perez, Jason White, Elizabeth Ravenberg, Alyson Clayborn, Mark Pagel, Huiqin Chen, Jia Sun, Peng Wei, Alastair M. Thompson, Stacy Moulder, Anil Korkut, Lei Huo, Kelly K. Hunt, Jennifer K. Litton, Vicente Valero, Debu Tripathy, Clinton Yam, Jingfei Ma, Gaiane Rauch. Longitudinal DCE-MRI Radiomic Models for Early Prediction of Response to Neoadjuvant Systemic Therapy (NAST) in Triple Negative Breast Cancer (TNBC) Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-01-34.
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Affiliation(s)
| | - Rania M. Mohamed
- 2The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beatriz Adrada
- 3University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Wei Yang
- 6Department of Breast Imaging - University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Medine Boge
- 7The University of Texas MD Anderson Cancer Center
| | - Miral Patel
- 8University of Texas MD Anderson Cancer Center
| | | | - Sanaz Pashapoor
- 10University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zijian Zhou
- 11The University of Texas MD Anderson Cancer Center
| | | | | | | | | | | | - Gary J. Whitman
- 17The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhan Xu
- 18MD Anderson Cancer Center, Texas
| | | | | | | | - Jason White
- 22The University of Texas MD Anderson Cancer Center
| | | | | | - Mark Pagel
- 25The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Huiqin Chen
- 26The University of Texas MD Anderson Cancer Center
| | - Jia Sun
- 27The University of Texas MD Anderson Cancer Center
| | - Peng Wei
- 28The University of Texas MD Anderson Cancer Center
| | | | | | - Anil Korkut
- 31The University of Texas MD Anderson Cancer Center
| | - Lei Huo
- 32The University of Texas MD Anderson Cancer Center
| | - Kelly K. Hunt
- 33The University of Texas MD Anderson Cancer Center, Texas
| | | | - Vicente Valero
- 35Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center,, Houston, Texas
| | - Debu Tripathy
- 36The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clinton Yam
- 37Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center
| | - Jingfei Ma
- 38University of Texas MD Anderson Cancer Center
| | - Gaiane Rauch
- 39The University of Texas MD Anderson Cancer Center
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Yam C, Li Z, Korkut A, Ma W, Kong E, Hill HA, Abbas H, Abouharb S, Adrada B, Arun BK, Barcenas CH, Bisen A, Booser D, Buzdar A, Candelaria R, Chen J, Clayborn A, Damodaran S, Ding Q, Garber H, Hortobagyi GN, Hunt KK, Ibrahim NK, Iheme A, Karuturi MS, Koenig K, Layman RM, Lee J, Litton JK, Mitchell M, Moscol G, Mouabbi J, Murthy RK, Oke O, Pohlmann P, Ramirez D, Ravenberg E, Saleem S, Teshome M, Valero V, White J, Williams M, Woodward W, Yajima C, Ueno NT, Chen K, Rauch G, Huo L, Tripathy D. Abstract HER2-01: HER2-01 Clinical and Molecular Characteristics of HER2-low/zero Early Stage Triple-Negative Breast Cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-her2-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: In the metastatic setting, low HER2 expression is associated with clinical benefit from trastuzumab deruxtecan, a HER2-targeting antibody drug conjugates. However, little is known about the biological significance of low HER2 expression in patients with early stage triple-negative breast cancer (TNBC) receiving neoadjuvant therapy (NAT). Methods: Out of 595 patients with stage I-III TNBC enrolled on the prospective ARTEMIS trial (NCT02276443) from 2015-2021, we identified 367 patients with available HER2 immunohistochemistry (IHC) results on pre-NAT tumor tissue (HER2-zero: n=218; HER2-low [IHC 1+, 2+]: n=149). All patients were treated with anthracycline-based NAT. In cases where sufficient pre-NAT tumor tissue were available, additional IHC and/or RNAseq were performed. Differential gene expression (DGE) and pathway analysis were performed using DEseq2. Gene set enrichment analysis (GSEA) was performed using the Hallmark gene sets. Deconvolution analyses were performed using CIBERSORT. We controlled for multiple hypothesis using a false discovery rate (FDR) threshold with the Benjamini-Hochberg method, accepting as significant genes with at least a 2-fold change and < 5% FDR. Results: Table 1 summarizes baseline clinicopathological features of the 367 patients. Compared to HER2-zero tumors, HER2-low tumors were less likely of metaplastic histology (p=0.001), associated with lower Ki67 (p=0.017) and were more likely to be androgen receptor (AR)-positive (p=0.01). There were no significant differences in tumor-infiltrating lymphocytes (TILs) infiltration and PD-L1 expression between HER2-zero and HER2-low tumors. Among the 226 patients with sufficient pre-NAT tissue for RNAseq, DGE analyses demonstrated upregulation of genes involved in fatty acid metabolism (ACSM1) and steroid hormone metabolism (DHRS2, UGT2B28) in HER2-low tumors compared with HER2-zero tumors. Deconvolution analyses revealed no significant differences between predicted proportions of immune cell subpopulations between HER2-low and HER2-zero tumors. Although rates of pCR were not significantly different between patients with HER2-zero (46%) and HER2-low tumors (40%) (p=0.34), non-pCR in patients with HER2-low tumors was associated with increased expression of EREG, which encodes an EGFR ligand, while non-pCR in patients with HER2-zero tumors was associated with downregulation in genes involved in immune response pathways. GSEA further identified the Hallmark allograft rejection (FDR q=0.001), interferon gamma response (FDR q=0.002), and interferon alpha response pathways (FDR q=0.007) as the 3 most significantly downregulated pathways in HER2-zero tumors from patients experiencing a non-pCR relative to HER2-zero tumors from patients experiencing a pCR. Conclusion: In early stage TNBC, low HER2 expression is associated with increased AR expression and upregulation of genes associated with fatty acid and steroid hormone metabolism. Gene expression analyses suggest that drivers of resistance to NAT differ between HER2-low and HER2-zero tumors. Biological differences between HER2-zero and HER2-low tumors exist and may influence future personalized treatment for patients with early stage TNBC.
Citation Format: Clinton Yam, Ziyi Li, Anil Korkut, Wencai Ma, Elisabeth Kong, Holly A. Hill, Hussein Abbas, Sausan Abouharb, Beatriz Adrada, Banu K. Arun, Carlos H. Barcenas, Ajit Bisen, Daniel Booser, Aman Buzdar, Rosalind Candelaria, Junjie Chen, Alyson Clayborn, Senthil Damodaran, Qingqing Ding, Haven Garber, Gabriel N. Hortobagyi, Kelly K. Hunt, Nuhad K. Ibrahim, Adaeze Iheme, Meghan S. Karuturi, Kimberly Koenig, Rachel M. Layman, Jangsoon Lee, Jennifer K. Litton, Melissa Mitchell, Giancarlo Moscol, Jason Mouabbi, Rashmi K. Murthy, Oluchi Oke, Paula Pohlmann, David Ramirez, Elizabeth Ravenberg, Sadia Saleem, Mediget Teshome, Vicente Valero, Jason White, Madison Williams, Wendy Woodward, Chasity Yajima, Naoto T. Ueno, Ken Chen, Gaiane Rauch, Lei Huo, Debu Tripathy. HER2-01 Clinical and Molecular Characteristics of HER2-low/zero Early Stage Triple-Negative Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr HER2-01.
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Affiliation(s)
- Clinton Yam
- 1Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center
| | - Ziyi Li
- 2The University of Texas MD Anderson Cancer Center
| | - Anil Korkut
- 3The University of Texas MD Anderson Cancer Center
| | - Wencai Ma
- 4The University of Texas MD Anderson Cancer Center
| | | | | | | | | | - Beatriz Adrada
- 9University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Aman Buzdar
- 14The University of Texas MD Anderson Cancer Center
| | | | | | | | | | | | | | | | - Kelly K. Hunt
- 22The University of Texas MD Anderson Cancer Center, Texas
| | | | | | | | | | | | - Jangsoon Lee
- 28The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Rashmi K. Murthy
- 33The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | - Vicente Valero
- 40Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason White
- 41The University of Texas MD Anderson Cancer Center
| | | | | | | | - Naoto T. Ueno
- 45The University of Texas MD Anderson Cancer Center, Houston, TX, Texas, USA
| | | | - Gaiane Rauch
- 47The University of Texas MD Anderson Cancer Center
| | - Lei Huo
- 48The University of Texas MD Anderson Cancer Center
| | - Debu Tripathy
- 49The University of Texas MD Anderson Cancer Center, Houston, TX, Texas, USA
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20
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Guirguis MS, Adrada B, Patel M, Perez F, Candelaria R, Yang W, Sun J, Mohamed RM, Boge M, Le-Petross HTC, Leung J, Whitman GJ, Lane DL, Scoggins ME, Moseley T, Musall B, White J, Pashapoor S, Wei P, Son JB, Hwang KP, Panthi B, Pagel M, Huo L, Hunt KK, Ravenberg E, Thompson AM, Litton JK, Valero V, Tripathy D, Moulder S, Yam C, Ma J, Rauch G. Abstract P1-05-15: DCE-MRI for early prediction of excellent response versus chemoresistance in triple negative breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-05-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
PURPOSE Triple-negative breast cancer (TNBC) is a heterogeneous disease with variable response to neoadjuvant therapy (NAT). Pathologic complete response (pCR) has become a prognostic marker for overall and disease-free survival. The aim of this study was to determine if dynamic contrast-enhanced (DCE)-MRI after 2 and/or 4 cycles of NAT can identify patients with a high likelihood of achieving pCR, triaging them to standard of care (SOC), or, when appropriate, to de-escalation trials. Conversely, we aimed to identify chemoresistant tumors that are unlikely to achieve pCR and may benefit from escalated targeted trials.
METHOD AND MATERIALS 309 patients with stage I-III TNBC underwent DCE-MRI (temporal resolution: 9-12 sec) at baseline (BL), 2 cycles (C2), and 4 cycles (C4) of SOC doxorubicin/cyclophosphamide (AC) NAT as part of a prospective IRB-approved study (NCT02276443). Tumor volumes of the index lesion were calculated using 3 axis measurements during the early phase of the DCE-MRI (60s). Percent tumor volume reduction (TVR) between BL, C2, and C4 was calculated. Patients were randomly assigned to a training or a validation cohort in a 1:1 ratio. pCR was assessed at surgery after completion of SOC NAT. Correlation between pCR and TVR was evaluated using ROC analysis.
RESULTS Of 309 TNBC patients, 136 (44%) achieved pCR. Following 2 cycles of NAT, TVR >80% was predictive of pCR (chemosensitivity), while TVR ≤ 55% was predictive of non-pCR (chemoresistance) with PPV 80%, NPV 89%, AUC 0.811 (0.73~0.893, p< 0.0001) in the training cohort, and PPV 82%, NPV 85%, AUC 0.815 (CI:0.736~0.894, p< 0.0001) in the validation cohort. Following 4 cycles of NAT, TVR >90% was predictive of pCR, while TVR ≤80% was predictive of non-pCR with PPV 80%, NPV 84%, AUC 0.827 (0.756~0.898, p< 0.0001) in the training cohort and with PPV 73%, NPV 82%, AUC 0.785 (CI:0.709~0.862, p< 0.001) in the validation cohort. Using this model, the pCR status was correctly classified in 50% of TNBC patients using C2 DCE-MRI in the training cohort, and 54% in the validation cohort. Only 8% were misclassified in the training cohort, and 10% in the validation cohort. Using C4 DCE-MRI, the pCR status of 61% and 57% of TNBC was correctly classified in the validation and the testing cohorts, respectively. 12% were misclassified in the validation cohort, and 21% in the testing cohort.
CONCLUSION DCE-MRI after 2 and 4 cycles of AC-based NAT correctly predicted the pCR status of 54% and 57% of TNBC patients, respectively, as either excellent responders or nonresponders with high AUC 0.811 and 0.827. This may allow patients to be triaged to SOC NAT with option of de-escalation or early targeted therapies for non-responders.
Citation Format: Mary S. Guirguis, Beatriz Adrada, Miral Patel, Frances Perez, Rosalind Candelaria, Wei Yang, Jia Sun, Rania M. Mohamed, Medine Boge, H. T. Carisa Le-Petross, Jessica Leung, Gary J. Whitman, Deanna L. Lane, Marion E. Scoggins, Tanya Moseley, Benjamin Musall, Jason White, Sanaz Pashapoor, Peng Wei, Jong Bum Son, Ken-Pin Hwang, Bikash Panthi, Mark Pagel, Lei Huo, Kelly K. Hunt, Elizabeth Ravenberg, Alastair M. Thompson, Jennifer K. Litton, Vicente Valero, Debu Tripathy, Stacy Moulder, Clinton Yam, Jingfei Ma, Gaiane Rauch. DCE-MRI for early prediction of excellent response versus chemoresistance in triple negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-15.
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Affiliation(s)
| | - Beatriz Adrada
- 2University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Miral Patel
- 3University of Texas MD Anderson Cancer Center
| | | | | | - Wei Yang
- 6Department of Breast Imaging - University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jia Sun
- 7The University of Texas MD Anderson Cancer Center
| | - Rania M. Mohamed
- 8The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Medine Boge
- 9The University of Texas MD Anderson Cancer Center
| | | | | | - Gary J. Whitman
- 12The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Jason White
- 17The University of Texas MD Anderson Cancer Center17
| | - Sanaz Pashapoor
- 18University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peng Wei
- 19The University of Texas MD Anderson Cancer Center
| | - Jong Bum Son
- 20University of Texas MD Anderson Cancer Center20
| | | | - Bikash Panthi
- 22The University of Texas MD Anderson cancer center22
| | - Mark Pagel
- 23The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lei Huo
- 24The University of Texas MD Anderson Cancer Center24
| | - Kelly K. Hunt
- 25The University of Texas MD Anderson Cancer Center, Texas
| | | | | | | | - Vicente Valero
- 29Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center,, Houston, Texas
| | - Debu Tripathy
- 30The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Clinton Yam
- 32Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center
| | - Jingfei Ma
- 33University of Texas MD Anderson Cancer Center
| | - Gaiane Rauch
- 34The University of Texas MD Anderson Cancer Center
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21
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Musall BC, Adrada BE, Candelaria RP, Mohamed RMM, Abdelhafez AH, Son JB, Sun J, Santiago L, Whitman GJ, Moseley TW, Scoggins ME, Mahmoud HS, White JB, Hwang KP, Elshafeey NA, Boge M, Zhang S, Litton JK, Valero V, Tripathy D, Thompson AM, Yam C, Wei P, Moulder SL, Pagel MD, Yang WT, Ma J, Rauch GM. Quantitative Apparent Diffusion Coefficients From Peritumoral Regions as Early Predictors of Response to Neoadjuvant Systemic Therapy in Triple-Negative Breast Cancer. J Magn Reson Imaging 2022; 56:1901-1909. [PMID: 35499264 PMCID: PMC9626398 DOI: 10.1002/jmri.28219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pathologic complete response (pCR) to neoadjuvant systemic therapy (NAST) in triple-negative breast cancer (TNBC) is a strong predictor of patient survival. Edema in the peritumoral region (PTR) has been reported to be a negative prognostic factor in TNBC. PURPOSE To determine whether quantitative apparent diffusion coefficient (ADC) features from PTRs on reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) predict the response to NAST in TNBC. STUDY TYPE Prospective. POPULATION/SUBJECTS A total of 108 patients with biopsy-proven TNBC who underwent NAST and definitive surgery during 2015-2020. FIELD STRENGTH/SEQUENCE A 3.0 T/rFOV single-shot diffusion-weighted echo-planar imaging sequence (DWI). ASSESSMENT Three scans were acquired longitudinally (pretreatment, after two cycles of NAST, and after four cycles of NAST). For each scan, 11 ADC histogram features (minimum, maximum, mean, median, standard deviation, kurtosis, skewness and 10th, 25th, 75th, and 90th percentiles) were extracted from tumors and from PTRs of 5 mm, 10 mm, 15 mm, and 20 mm in thickness with inclusion and exclusion of fat-dominant pixels. STATISTICAL TESTS ADC features were tested for prediction of pCR, both individually using Mann-Whitney U test and area under the receiver operating characteristic curve (AUC), and in combination in multivariable models with k-fold cross-validation. A P value < 0.05 was considered statistically significant. RESULTS Fifty-one patients (47%) had pCR. Maximum ADC from PTR, measured after two and four cycles of NAST, was significantly higher in pCR patients (2.8 ± 0.69 vs 3.5 ± 0.94 mm2 /sec). The top-performing feature for prediction of pCR was the maximum ADC from the 5-mm fat-inclusive PTR after cycle 4 of NAST (AUC: 0.74; 95% confidence interval: 0.64, 0.84). Multivariable models of ADC features performed similarly for fat-inclusive and fat-exclusive PTRs, with AUCs ranging from 0.68 to 0.72 for the cycle 2 and cycle 4 scans. DATA CONCLUSION Quantitative ADC features from PTRs may serve as early predictors of the response to NAST in TNBC. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Benjamin C Musall
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rosalind P Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rania M M Mohamed
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abeer H Abdelhafez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary J Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tanya W Moseley
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marion E Scoggins
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagar S Mahmoud
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nabil A Elshafeey
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Medine Boge
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shu Zhang
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alastair M Thompson
- Division of Surgical Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stacy L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark D Pagel
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei T Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gaiane M Rauch
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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22
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Wu C, Jarrett AM, Zhou Z, Elshafeey N, Adrada BE, Candelaria RP, Mohamed RMM, Boge M, Huo L, White JB, Tripathy D, Valero V, Litton JK, Yam C, Son JB, Ma J, Rauch GM, Yankeelov TE. MRI-Based Digital Models Forecast Patient-Specific Treatment Responses to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer. Cancer Res 2022; 82:3394-3404. [PMID: 35914239 PMCID: PMC9481712 DOI: 10.1158/0008-5472.can-22-1329] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/14/2022] [Accepted: 07/26/2022] [Indexed: 02/07/2023]
Abstract
Triple-negative breast cancer (TNBC) is persistently refractory to therapy, and methods to improve targeting and evaluation of responses to therapy in this disease are needed. Here, we integrate quantitative MRI data with biologically based mathematical modeling to accurately predict the response of TNBC to neoadjuvant systemic therapy (NAST) on an individual basis. Specifically, 56 patients with TNBC enrolled in the ARTEMIS trial (NCT02276443) underwent standard-of-care doxorubicin/cyclophosphamide (A/C) and then paclitaxel for NAST, where dynamic contrast-enhanced MRI and diffusion-weighted MRI were acquired before treatment and after two and four cycles of A/C. A biologically based model was established to characterize tumor cell movement, proliferation, and treatment-induced cell death. Two evaluation frameworks were investigated using: (i) images acquired before and after two cycles of A/C for calibration and predicting tumor status after A/C, and (ii) images acquired before, after two cycles, and after four cycles of A/C for calibration and predicting response following NAST. For Framework 1, the concordance correlation coefficients between the predicted and measured patient-specific, post-A/C changes in tumor cellularity and volume were 0.95 and 0.94, respectively. For Framework 2, the biologically based model achieved an area under the receiver operator characteristic curve of 0.89 (sensitivity/specificity = 0.72/0.95) for differentiating pathological complete response (pCR) from non-pCR, which is statistically superior (P &lt; 0.05) to the value of 0.78 (sensitivity/specificity = 0.72/0.79) achieved by tumor volume measured after four cycles of A/C. Overall, this model successfully captured patient-specific, spatiotemporal dynamics of TNBC response to NAST, providing highly accurate predictions of NAST response. SIGNIFICANCE Integrating MRI data with biologically based mathematical modeling successfully predicts breast cancer response to chemotherapy, suggesting digital twins could facilitate a paradigm shift from simply assessing response to predicting and optimizing therapeutic efficacy.
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Affiliation(s)
- Chengyue Wu
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas
| | - Angela M Jarrett
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas.,Livestrong Cancer Institutes, The University of Texas at Austin, Austin, Texas
| | - Zijian Zhou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nabil Elshafeey
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rosalind P Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rania M M Mohamed
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Medine Boge
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gaiane M Rauch
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas E Yankeelov
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas.,Livestrong Cancer Institutes, The University of Texas at Austin, Austin, Texas.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas.,Department of Diagnostic Medicine, The University of Texas at Austin, Austin, Texas.,Department of Oncology, The University of Texas at Austin, Austin, Texas
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23
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Kumar T, Hobbs E, Yang F, Chang JT, Contreras A, Cuentas ERP, Garber H, Lee S, Lu Y, Scoggins ME, Adrada BE, Whitman GJ, Arun BK, Mittendorf EA, Litton JK. Tumor Immune Microenvironment Changes by Multiplex Immunofluorescence Staining in a Pilot Study of Neoadjuvant Talazoparib for Early-Stage Breast Cancer Patients with a Hereditary BRCA Mutation. Clin Cancer Res 2022; 28:3669-3676. [PMID: 35736816 PMCID: PMC9444971 DOI: 10.1158/1078-0432.ccr-21-1278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/19/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The immunological profile of early-stage breast cancer treated with neoadjuvant PARP inhibitors has not been described. The aim of this study was to delineate the changes in the tumor immune microenvironment (TiME) induced by talazoparib. PATIENTS AND METHODS Patients with operable germline BRCA1/2 pathogenic variant (gBRCA1/2+) breast cancer were enrolled in a feasibility study of neoadjuvant talazoparib. Thirteen patients who received 8 weeks of neoadjuvant talazoparib were available for analysis, including 11 paired pre- and post-talazoparib core biopsies. Treatment-related changes in tumor-infiltrating lymphocytes were examined and immune cell phenotypes and their spatial distribution in the TiME were identified and quantified by multiplex immunofluorescence using a panel of 6 biomarkers (CD3, CD8, CD68, PD-1, PD-L1, and CK). RESULTS Neoadjuvant talazoparib significantly increased infiltrating intratumoral and stromal T-cell and cytotoxic T-cell density. There was no difference in PD-1 or PD-L1 immune cell phenotypes in the pre- and post-talazoparib specimens and PD-L1 expression in tumor cells was rare in this cohort. Spatial analysis demonstrated that pre-talazoparib interactions between macrophages and T cells may correlate with pathologic complete response. CONCLUSIONS This is the first study with phenotyping to characterize the immune response to neoadjuvant talazoparib in patients with gBRCA1/2+ breast cancer. These findings support an emerging role for PARP inhibitors in enhancing tumor immunogenicity. Further investigation of combinatorial strategies is warranted with agents that exploit the immunomodulatory effects of PARP inhibitors on the TiME.
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Affiliation(s)
- Tapsi Kumar
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, Texas
| | - Evie Hobbs
- Division of Cancer Medicine Fellowship Program, The University of Texas MD Anderson Cancer Center
| | - Fei Yang
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey T. Chang
- Department of Integrative Biology and Pharmacology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Alejandro Contreras
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Haven Garber
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanghoon Lee
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yiling Lu
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marion E. Scoggins
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beatriz E. Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary J. Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Banu K. Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth A. Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital Boston, MA
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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24
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Yam C, Abuhadra N, Sun R, Adrada BE, Ding QQ, White JB, Ravenberg EE, Clayborn AR, Valero V, Tripathy D, Damodaran S, Arun BK, Litton JK, Ueno NT, Murthy RK, Lim B, Baez L, Li X, Buzdar AU, Hortobagyi GN, Thompson AM, Mittendorf EA, Rauch GM, Candelaria RP, Huo L, Moulder SL, Chang JT. Molecular Characterization and Prospective Evaluation of Pathologic Response and Outcomes with Neoadjuvant Therapy in Metaplastic Triple-Negative Breast Cancer. Clin Cancer Res 2022; 28:2878-2889. [PMID: 35507014 PMCID: PMC9250637 DOI: 10.1158/1078-0432.ccr-21-3100] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/28/2022] [Accepted: 04/29/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Metaplastic breast cancer (MpBC) is a rare subtype of breast cancer that is commonly triple-negative and poorly responsive to neoadjuvant therapy in retrospective studies. EXPERIMENTAL DESIGN To better define clinical outcomes and correlates of response, we analyzed the rate of pathologic complete response (pCR) to neoadjuvant therapy, survival outcomes, and genomic and transcriptomic profiles of the pretreatment tumors in a prospective clinical trial (NCT02276443). A total of 211 patients with triple-negative breast cancer (TNBC), including 39 with MpBC, received doxorubicin-cyclophosphamide-based neoadjuvant therapy. RESULTS Although not meeting the threshold for statistical significance, patients with MpBCs were less likely to experience a pCR (23% vs. 40%; P = 0.07), had shorter event-free survival (29.4 vs. 32.2 months, P = 0.15), metastasis-free survival (30.3 vs. 32.4 months, P = 0.22); and overall survival (32.6 vs. 34.3 months, P = 0.21). This heterogeneity is mirrored in the molecular profiling. Mutations in PI3KCA (23% vs. 9%, P = 0.07) and its pathway (41% vs. 18%, P = 0.02) were frequently observed and enriched in MpBCs. The gene expression profiles of each histologically defined subtype were distinguishable and characterized by distinctive gene signatures. Among nonmetaplastic (non-Mp) TNBCs, 10% possessed a metaplastic-like gene expression signature and had pCR rates and survival outcomes similar to MpBC. CONCLUSIONS Further investigations will determine if metaplastic-like tumors should be treated more similarly to MpBC in the clinic. The 23% pCR rate in this study suggests that patients with MpBC should be considered for NAT. To improve this rate, a pathway analysis predicted enrichment of histone deacetylase (HDAC) and RTK/MAPK pathways in MpBC, which may serve as new targetable vulnerabilities.
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Affiliation(s)
- Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nour Abuhadra
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beatriz E. Adrada
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qing-Qing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason B. White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth E. Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alyson R. Clayborn
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Senthilkumar Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu K. Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T. Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rashmi K. Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bora Lim
- Department of Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Luis Baez
- PROncology (Private Practice), University of Puerto Rico. San Juan, Puerto Rico
| | - Xiaoxian Li
- Department of Pathology & Laboratory Medicine, Winship Cancer Institute - Emory University Hospital, Atlanta, GA, USA
| | - Aman U. Buzdar
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel N. Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alistair M. Thompson
- Division of Surgical Oncology, Section of Breast Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Elizabeth A. Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MD, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA
| | - Gaiane M. Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosalind P. Candelaria
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stacy L. Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey T. Chang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Integrative Biology and Pharmacology, The University of Texas Health Science Center at Houston, TX, USA
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Chen M, Gao Y, Xia W, Wang YH, Litton JK, Chu YY, Meric-Bernstam F, Piwnica-Worms H, Arun B, Ahnert JR, Wei Y, Chang WC, Wang HL, Tapia C, Albarracin CT, Wang SC, Wang YN, Hortobagyi GN, Lin C, Yang L, Yu D, Hung MC. Abstract 1792: FGFR3 mediated PARP1 tyrosine 158 phosphorylation promotes PARP inhibitor resistance. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Poly(ADP-ribose) polymerase (PARP) inhibitors (PARPi), which induce DNA damage by inhibiting PARP1 enzymatic activity and trapping PARP on the damaged DNA, are used to eliminate BRCA1/2-mutated (BRCAm) cancer. However, clinical observations suggest that BRCAm tumors develop PARPi resistance. Current strategies to overcome PARPi resistance include impeding multiple DNA repair pathways to induce excessive DNA damage. Here, we propose a novel strategy targeting oncogenic receptor tyrosine kinases to enhance PARP trapping. By developing triple-negative breast cancer (TNBC) cells with acquired talazoparib resistance, we observed a high prevalence of activated fibroblast growth factor receptor 3 (FGFR3) kinase in these cells through kinase antibody array analysis. Mass spectrometry analysis and in vitro kinase assay suggested that FGFR3 phosphorylated PARP1 at tyrosine residues 158 and 176. Biochemistry studies suggested that only PARP1 tyrosine 158 phosphorylation contributes to PARPi resistance in the cells we developed. We then developed a monoclonal antibody against tyrosine 158 phosphorylated PARP1, and found that high-level PARP1 tyrosine 158 phosphorylation positively correlated with PARPi resistance in breast cancer patient-derived xenograft models. We further demonstrated that the combination of FGFR inhibitor and PARPi delayed DNA repair with prolonged PARP trapping. Moreover, synergy between PARPi and FGFR inhibition was observed in multiple TNBC cell lines with PARPi resistance in vitro. The combination of PARPi and FGFR inhibitor also showed synergism in vivo, and treatment with the combination of PARPi and FGFR inhibitor was tolerated in mouse models. These findings reveal that PARP1 tyrosine 158 phosphorylation facilitates resolving of the PARPi-induced PARP-trapping, and that the tyrosine 158 phosphorylated PARP1 may be an effective biomarker to indicate FGFR3 mediated PARPi resistance.
Citation Format: MeiKuang Chen, Yuan Gao, Weiya Xia, Yu-Han Wang, Jennifer K. Litton, Yu-Yi Chu, Funda Meric-Bernstam, Helen Piwnica-Worms, Banu Arun, Jordi Rodon Ahnert, Yongkun Wei, Wei-Chao Chang, Hung-Ling Wang, Coya Tapia, Constance T. Albarracin, Shao-Chun Wang, Ying-Nai Wang, Gabriel N. Hortobagyi, Chunru Lin, Liuqing Yang, Dihua Yu, Mien-Chie Hung. FGFR3 mediated PARP1 tyrosine 158 phosphorylation promotes PARP inhibitor resistance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1792.
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Affiliation(s)
- MeiKuang Chen
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yuan Gao
- 2Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiya Xia
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Yu-Yi Chu
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Banu Arun
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yongkun Wei
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Coya Tapia
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ying-Nai Wang
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Chunru Lin
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Liuqing Yang
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dihua Yu
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
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26
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Liu X, Ge Z, Yang F, Contreras A, Lee S, White JB, Lu Y, Labrie M, Arun BK, Moulder SL, Mills GB, Piwnica-Worms H, Litton JK, Chang JT. Identification of biomarkers of response to preoperative talazoparib monotherapy in treatment naïve gBRCA+ breast cancers. NPJ Breast Cancer 2022; 8:64. [PMID: 35538088 PMCID: PMC9090765 DOI: 10.1038/s41523-022-00427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Germline mutations in BRCA1 or BRCA2 exist in ~2–7% of breast cancer patients, which has led to the approval of PARP inhibitors in the advanced setting. We have previously reported a phase II neoadjuvant trial of single agent talazoparib for patients with germline BRCA pathogenic variants with a pathologic complete response (pCR) rate of 53%. As nearly half of the patients treated did not have pCR, better strategies are needed to overcome treatment resistance. To this end, we conducted multi-omic analysis of 13 treatment naïve breast cancer tumors from patients that went on to receive single-agent neoadjuvant talazoparib. We looked for biomarkers that were predictive of response (assessed by residual cancer burden) after 6 months of therapy. We found that all resistant tumors exhibited either the loss of SHLD2, expression of a hypoxia signature, or expression of a stem cell signature. These results indicate that the deep analysis of pre-treatment tumors can identify biomarkers that are predictive of response to talazoparib and potentially other PARP inhibitors, and provides a framework that will allow for better selection of patients for treatment, as well as a roadmap for the development of novel combination therapies to prevent emergence of resistance.
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Affiliation(s)
- Xuan Liu
- Department of Integrative Biology and Pharmacology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zhongqi Ge
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fei Yang
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alejandro Contreras
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanghoon Lee
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yiling Lu
- Department of Genome Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marilyne Labrie
- Department of Cell, Developmental, and Cancer Biology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Banu K Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stacy L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gordon B Mills
- Department of Cell, Developmental, and Cancer Biology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Helen Piwnica-Worms
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey T Chang
- Department of Integrative Biology and Pharmacology, University of Texas Health Science Center at Houston, Houston, TX, USA. .,Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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27
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Blum JL, Laird AD, Litton JK, Rugo HS, Ettl J, Hurvitz SA, Martin M, Roché HH, Lee KH, Goodwin A, Chen Y, Lanzalone S, Chelliserry J, Czibere A, Hopkins JF, Albacker LA, Mina LA. Determinants of Response to Talazoparib in Patients with HER2-Negative, Germline BRCA1/2-Mutated Breast Cancer. Clin Cancer Res 2022; 28:1383-1390. [PMID: 35091441 PMCID: PMC9365365 DOI: 10.1158/1078-0432.ccr-21-2080] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/18/2021] [Accepted: 01/25/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE PARP inhibitors (PARPi) have demonstrated efficacy in tumors with germline breast cancer susceptibility genes (gBRCA) 1 and 2 mutations, but further factors influencing response to PARPi are poorly understood. EXPERIMENTAL DESIGN Breast cancer tumor tissue from patients with gBRCA1/2 mutations from the phase III EMBRACA trial of the PARPi talazoparib versus chemotherapy was sequenced using FoundationOne CDx. RESULTS In the evaluable intent-to-treat population, 96.1% (296/308) had ≥1 tumor BRCA (tBRCA) mutation and there was strong concordance (95.3%) between tBRCA and gBRCA mutational status. Genetic/genomic characteristics including BRCA loss of heterozygosity (LOH; identified in 82.6% of evaluable patients), DNA damage response (DDR) gene mutational burden, and tumor homologous recombination deficiency [assessed by genomic LOH (gLOH)] demonstrated no association with talazoparib efficacy. CONCLUSIONS Overall, BRCA LOH status, DDR gene mutational burden, and gLOH were not associated with talazoparib efficacy; however, these conclusions are qualified by population heterogeneity and low patient numbers in some subgroups. Further investigation in larger patient populations is warranted.
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Affiliation(s)
- Joanne L. Blum
- Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, Texas.,Corresponding Author: Joanne L. Blum, Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology, 3410 Worth Street, Suite 400, Dallas, TX 75246. Phone: 214-370-1050; E-mail:
| | | | | | - Hope S. Rugo
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sara A. Hurvitz
- University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain
| | - Henri H. Roché
- Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse, France
| | - Kyung-Hun Lee
- Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | - Lida A. Mina
- Banner MD Anderson Cancer Center at Banner Gateway Medical Center, Gilbert, Arizona
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28
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Jimenez JE, Abdelhafez A, Mittendorf EA, Elshafeey N, Yung JP, Litton JK, Adrada BE, Candelaria RP, White J, Thompson AM, Huo L, Wei P, Tripathy D, Valero V, Yam C, Hazle JD, Moulder SL, Yang WT, Rauch GM. A model combining pretreatment MRI radiomic features and tumor-infiltrating lymphocytes to predict response to neoadjuvant systemic therapy in triple-negative breast cancer. Eur J Radiol 2022; 149:110220. [DOI: 10.1016/j.ejrad.2022.110220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/13/2021] [Accepted: 02/10/2022] [Indexed: 12/20/2022]
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29
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Rugo HS, Blum JL, Laird AD, Hurvitz SA, Ettl J, Mina LA, Lee KH, Gonçalves A, Yerushalmi R, Im YH, Martin M, Fehrenbacher L, Roché HH, Chen Y, Lanzalone S, Chelliserry J, Eiermann W, Litton JK. Abstract P5-13-08: Identification of PD-L1+ status as a candidate predictive biomarker of response to talazoparib (TALA) in the phase 3 EMBRACA study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-13-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Loss-of-function mutations in genes encoding components of the homologous recombination DNA damage response (DDR) machinery, notably BRCA1/2, are associated with tumor sensitivity to poly(ADP-ribose) polymerase inhibitors (PARPi). In EMBRACA, the PARPi TALA improved progression-free survival (PFS) (HR [95% CI] 0.54 [0.41-0.71], P<0.001) vs chemotherapy (CT) in germline BRCA-mutated (gBRCAm) HER2− advanced breast cancer. BRCA1/2 deficiency is associated with elevated PD-L1 expression in ovarian cancers, and PARP inhibition has been associated with PD-L1 upregulation in nonclinical models (Stewart et al, Cancer Res 2018;78:6717-25). Little is known about the potential for PD-L1 expression to modulate sensitivity to PARPi monotherapy in the clinic. Recently, a neoadjuvant study of olaparib in unselected, primary triple-negative breast cancer (TNBC), demonstrated a significant correlation between PD-L1 expression (using the 22C3 antibody) and response to olaparib (Eikesdal et al, Ann Oncol 2021;32:240-9). In contrast, this EMBRACA analysis assessed the contribution of PD-L1 status to TALA sensitivity in a uniformly gBRCAm patient (pt) population. Methods: Available baseline tumor tissue blocks from 120 of 431 EMBRACA pts (28% of intent-to-treat) were sectioned and slides immunostained using SP142/Ventana anti-PD-L1 at HistoGeneX (Naperville, Illinois). PD-L1 immunohistochemistry (IHC) status was assessed as the proportion of tumor area occupied by PD-L1 stained immune cells (IC) of any intensity, with ≥1% defined as PD-L1+. The overall response rate (ORR), defined as unconfirmed complete or partial response (CR/PR), was assessed by investigators. PFS was assessed by an Independent Review Facility. Results: 92/120 (77%) tumors were evaluable for PD-L1 IHC status. Of these 92 evaluable tumors, 9/36 (25%) TNBC and 15/56 (27%) hormone receptor-positive (HR+) tumors were PD-L1+ (24/92, 26% combined TNBC and HR+). In the TALA arm, the ORR was similar for PD-L1+ and PD-L1− tumors for TNBC pts: 2/5 (40%) and 6/19 (32%), respectively. In contrast, the ORR was higher for PD-L1+ vs PD-L1− tumors for HR+ pts: 11/12 (92%) vs 12/31 (39%), exact P value=0.002 (for combined TNBC and HR+, 13/17 [76%] vs 18/50 [36%], P=0.005). For the CT arm, the limited numbers evaluable for both PD-L1 and response (n=25 total), with only one response, precluded similar analysis. Based on the imbalanced results in ORR according to PD-L1 status in pts with HR+ disease, Cox regression analysis was used to explore potential associations of PD-L1 status with PFS. In the TALA arm, median PFS was similar for TNBC independent of PD-L1 status (6.3 mo and 7.0 mo, respectively; HR [95% CI] 1.207 [0.371-3.929]). Median PFS was numerically longer for PD-L1+ vs PD-L1− for HR+ tumors; this difference was not significant (20.2 mo vs 9.2 mo; HR [95% CI] 1.154 [0.395-3.367]). In the CT arm, PD-L1 status was not associated with PFS, although the PD-L1 subgroups were small (For HR+: PD-L1+, n=3; PD-L1−, n=10). Conclusions: Based on these exploratory, retrospective subgroup analyses, PD-L1 positivity by SP142/Ventana was lower in EMBRACA than previously reported in TNBC using the same scoring algorithm: 24/92 (26%) vs 369/902 (41%) in IMpassion130 (Schmid et al, Lancet Oncol 2020;21:44-59). PD-L1+ status was associated with higher ORR in HR+ EMBRACA pts receiving TALA. Interestingly, the enhanced responsiveness for PD-L1+ was not associated with improved PFS, although this assessment is complicated by low pt numbers. Further research is warranted to explore the relationship between baseline tumor PD-L1 status and sensitivity to PARPi, particularly in light of ongoing clinical studies evaluating combinations of immunotherapy and PARPi.
Citation Format: Hope S. Rugo, Joanne L. Blum, A. Douglas Laird, Sara A. Hurvitz, Johannes Ettl, Lida A. Mina, Kyung-Hun Lee, Anthony Gonçalves, Rinat Yerushalmi, Young-Hyuck Im, Miguel Martin, Louis Fehrenbacher, Henri H. Roché, Ying Chen, Silvana Lanzalone, Jijumon Chelliserry, Wolfgang Eiermann, Jennifer K. Litton. Identification of PD-L1+ status as a candidate predictive biomarker of response to talazoparib (TALA) in the phase 3 EMBRACA study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-08.
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Affiliation(s)
- Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Joanne L. Blum
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas, TX
| | | | - Sara A. Hurvitz
- University of California, Los Angeles/Jonsson Comprehensive Cancer Center (UCLA/JCCC), Los Angeles, CA
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Kyung-Hun Lee
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea, Republic of
| | | | - Rinat Yerushalmi
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | | | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | | | - Henri H. Roché
- Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse, France
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Chapman BV, Liu D, Shen Y, Olamigoke OO, Lakomy DS, Barrera AMG, Stecklein SR, Sawakuchi GO, Bright SJ, Bedrosian I, Litton JK, Smith BD, Woodward WA, Perkins GH, Hoffman KE, Stauder MC, Strom EA, Arun BK, Shaitelman SF. Outcomes After Breast Radiation Therapy in a Diverse Patient Cohort With a Germline BRCA1/2 Mutation. Int J Radiat Oncol Biol Phys 2022; 112:426-436. [PMID: 34610390 PMCID: PMC9330175 DOI: 10.1016/j.ijrobp.2021.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE BRCA1/2 pathogenic variant (PV) mutations confer radiation sensitivity preclinically, but there are limited data regarding breast cancer outcomes after radiation therapy (RT) among patients with documented BRCA1/2 PV mutations versus no PV mutations. METHODS AND MATERIALS This retrospective cohort study included women with clinical stage I-III breast cancer who received definitive surgery and RT and underwent BRCA1/2 genetic evaluation at the The University of Texas MD Anderson Cancer Center. Rates of locoregional recurrence (LRR), disease-specific death (DSD), toxicities, and second cancers were compared by BRCA1/2 PV status. RESULTS Of the 2213 women who underwent BRCA1/2 testing, 63% self-reported their race as White, 13.6% as Black/African American, 17.6% as Hispanic, and 5.8% as Asian/American Indian/Alaska Native; 124 had BRCA1 and 100 had BRCA2 mutations; and 1394 (63%) received regional nodal RT. The median follow-up time for all patients was 7.4 years (95% confidence interval [CI], 7.1-7.7 years). No differences were found between the groups with and without BRCA1/2 PV mutations in 10-year cumulative incidences of LRR (with mutations: 11.6% [95% CI, 7.0%-17.6%]; without mutations: 6.6% [95% CI, 5.3%-8.0%]; P = .466) and DSD (with mutations: 12.3% [95% CI, 8.0%-17.7%]; without mutations: 13.8% [95% CI, 12.0%-15.8%]; P = .716). On multivariable analysis, BRCA1/2 status was not associated with LRR or DSD, but Black/African American patients (P = .036) and Asians/American Indians/Alaska Native patients (P = .002) were at higher risk of LRR compared with White patients, and Black/African American patients were at higher risk of DSD versus White patients (P = .004). No in-field, nonbreast second cancers were observed in the BRCA1/2 PV group. Rates of acute and late grade ≥3 radiation-related toxicity in the BCRA1/2 PV group were 5.4% (n = 12) and 0.4% (n = 1), respectively. CONCLUSIONS Oncologic outcomes in a diverse cohort of patients with breast cancer who had a germline BRCA1/2 PV mutation and were treated with RT were similar to those of patients with no mutation, supporting the use of RT according to standard indications in patients with a germline BRCA1/2 PV mutation.
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Affiliation(s)
- Bhavana V. Chapman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Liu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yu Shen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - David S. Lakomy
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angelica M. Gutierrez Barrera
- Department of Breast Medical Oncology and Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shane R. Stecklein
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriel O. Sawakuchi
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Scott J. Bright
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer K. Litton
- Department of Breast Medical Oncology and Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D. Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy A. Woodward
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George H. Perkins
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen E. Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael C. Stauder
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric A. Strom
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Banu K. Arun
- Department of Breast Medical Oncology and Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simona F. Shaitelman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Chapman BV, Liu D, Shen Y, Olamigoke OO, Lakomy DS, Gutierrez Barrera AM, Stecklein SR, Sawakuchi GO, Bright SJ, Bedrosian I, Litton JK, Smith BD, Woodward WA, Perkins GH, Hoffman KE, Stauder MC, Strom EA, Arun BK, Shaitelman SF. Breast Radiation Therapy-Related Treatment Outcomes in Patients With or Without Germline Mutations on Multigene Panel Testing. Int J Radiat Oncol Biol Phys 2022; 112:437-444. [PMID: 34582940 PMCID: PMC8748284 DOI: 10.1016/j.ijrobp.2021.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Multigene panel testing has increased the detection of germline mutations in patients with breast cancer. The implications of using radiation therapy (RT) to treat patients with pathogenic variant (PV) mutations are not well understood and have been studied mostly in women with only BRCA1 or BRCA2 PVs. We analyzed oncologic outcomes and toxicity after adjuvant RT in a contemporary, diverse cohort of patients with breast cancer who underwent genetic panel testing. METHODS AND MATERIALS We retrospectively reviewed the records of 286 women with clinical stage I-III breast cancer diagnosed from 1995 to 2017 who underwent surgery, breast or chest wall RT with or without regional nodal irradiation, multigene panel testing, and evaluation at a large cancer center's genetic screening program. We evaluated rates of overall survival, locoregional recurrence, disease-specific death, and radiation-related toxicities in 3 groups: BRCA1/2 PV carriers, non-BRCA1/2 PV carriers, and patients without PV mutations. RESULTS PVs were detected in 25.2% of the cohort (12.6% BRCA1/2 and 12.6% non-BRCA1/2). The most commonly detected non-BRCA1/2 mutated genes were ATM, CHEK2, PALB2, CDH1, TP53, and PTEN. The median follow-up time for the entire cohort was 4.4 years (95% confidence interval, 3.8-4.9 years). No differences were found in overall survival, locoregional recurrence, or disease-specific death between groups (P > .1 for all). Acute and late toxicities were comparable across groups. CONCLUSION Oncologic and toxicity outcomes after RT in women with PV germline mutations detected by multigene pane testing are similar to those in patients without detectable mutations, supporting the use of adjuvant RT as a standard of care when indicated.
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Affiliation(s)
- Bhavana V. Chapman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Oluwafikayo O. Olamigoke
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David S. Lakomy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angelica M. Gutierrez Barrera
- Department of Breast Medical Oncology and Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shane R. Stecklein
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriel O. Sawakuchi
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Scott J. Bright
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer K. Litton
- Department of Breast Medical Oncology and Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy A. Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George H. Perkins
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael C. Stauder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric A. Strom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Banu K. Arun
- Department of Breast Medical Oncology and Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simona F. Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Westin SN, Labrie M, Litton JK, Blucher A, Fang Y, Vellano CP, Marszalek JR, Feng N, Ma X, Creason A, Fellman B, Yuan Y, Lee S, Kim TB, Liu J, Chelariu-Raicu A, Chen TH, Kabil N, Soliman PT, Frumovitz M, Schmeler KM, Jazaeri A, Lu KH, Murthy R, Meyer LA, Sun CC, Sood AK, Coleman RL, Mills GB. Phase Ib Dose Expansion and Translational Analyses of Olaparib in Combination with Capivasertib in Recurrent Endometrial, Triple-Negative Breast, and Ovarian Cancer. Clin Cancer Res 2021; 27:6354-6365. [PMID: 34518313 PMCID: PMC8639651 DOI: 10.1158/1078-0432.ccr-21-1656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/07/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE On the basis of strong preclinical rationale, we sought to confirm recommended phase II dose (RP2D) for olaparib, a PARP inhibitor, combined with the AKT inhibitor capivasertib and assess molecular markers of response and resistance. PATIENTS AND METHODS We performed a safety lead-in followed by expansion in endometrial, triple-negative breast, ovarian, fallopian tube, or peritoneal cancer. Olaparib 300 mg orally twice daily and capivasertib orally twice daily on a 4-day on 3-day off schedule was evaluated. Two dose levels (DL) of capivasertib were planned: 400 mg (DL1) and 320 mg (DL-1). Patients underwent biopsies at baseline and 28 days. RESULTS A total of 38 patients were enrolled. Seven (18%) had germline BRCA1/2 mutations. The first 2 patients on DL1 experienced dose-limiting toxicities (DLT) of diarrhea and vomiting. No DLTs were observed on DL-1 (n = 6); therefore, DL1 was reexplored (n = 6) with no DLTs, confirming DL1 as RP2D. Most common treatment-related grade 3/4 adverse events were anemia (23.7%) and leukopenia (10.5%). Of 32 evaluable subjects, 6 (19%) had partial response (PR); PR rate was 44.4% in endometrial cancer. Seven (22%) additional patients had stable disease greater than 4 months. Tumor analysis demonstrated strong correlations between response and immune activity, cell-cycle alterations, and DNA damage response. Therapy resistance was associated with receptor tyrosine kinase and RAS-MAPK pathway activity, metabolism, and epigenetics. CONCLUSIONS The combination of olaparib and capivasertib is associated to no serious adverse events and demonstrates durable activity in ovarian, endometrial, and breast cancers, with promising responses in endometrial cancer. Importantly, tumor samples acquired pre- and on-therapy can help predict patient benefit.
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Affiliation(s)
- Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Marilyne Labrie
- Knight Cancer Institute and Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon
| | - Jennifer K Litton
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aurora Blucher
- Knight Cancer Institute and Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon
| | - Yong Fang
- Knight Cancer Institute and Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Ningping Feng
- TRACTION, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - XiaoYan Ma
- TRACTION, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Allison Creason
- Knight Cancer Institute and Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon
| | - Bryan Fellman
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Yuan
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanghoon Lee
- Department of Systems Biology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tae-Beom Kim
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jinsong Liu
- Department of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anca Chelariu-Raicu
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Tsun Hsuan Chen
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katheleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amir Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rashmi Murthy
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Gordon B Mills
- Knight Cancer Institute and Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon
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Kai M, Marx AN, Liu DD, Shen Y, Gao H, Reuben JM, Whitman G, Krishnamurthy S, Ross MI, Litton JK, Lim B, Ibrahim N, Kogawa T, Ueno NT. A phase II study of talimogene laherparepvec for patients with inoperable locoregional recurrence of breast cancer. Sci Rep 2021; 11:22242. [PMID: 34782633 PMCID: PMC8593093 DOI: 10.1038/s41598-021-01473-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/05/2021] [Indexed: 01/03/2023] Open
Abstract
Talimogene laherparepvec (T-VEC) is an immunotherapy that generates local tumor lysis and systemic antitumor immune response. We studied the efficacy of intratumoral administration of T-VEC as monotherapy for inoperable locoregional recurrence of breast cancer. T-VEC was injected intratumorally at 106 PFU/mL on day 1 (cycle 1), 108 PFU/mL on day 22 (cycle 2), and 108 PFU/mL every 2 weeks thereafter (cycles ≥ 3). Nine patients were enrolled, 6 with only locoregional disease and 3 with both locoregional and distant disease. No patient completed the planned 10 cycles or achieved complete or partial response. The median number of cycles administered was 4 (range, 3-8). Seven patients withdrew prematurely because of uncontrolled disease progression, 1 withdrew after cycle 3 because of fatigue, and 1 withdrew after cycle 4 for reasons unrelated to study treatment. Median progression-free survival and overall survival were 77 days (95% CI, 63-NA) and 361 days (95% CI, 240-NA). Two patients received 8 cycles with clinically stable disease as the best response. The most common grade 2 or higher adverse event was injection site reaction (n = 7, 78%). Future studies could examine whether combining intratumoral T-VEC with concurrent systemic therapy produces better outcomes.
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Affiliation(s)
- Megumi Kai
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Angela N Marx
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Hui Gao
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Hematopathology Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - James M Reuben
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Hematopathology Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Gary Whitman
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Savitri Krishnamurthy
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Merrick I Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Oncology/Medicine, Baylor College of Medicine, 7200 Cambridge St., Houston, TX, 77030, USA
| | - Nuhad Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Takahiro Kogawa
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA.
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Emens LA, Adams S, Cimino-Mathews A, Disis ML, Gatti-Mays ME, Ho AY, Kalinsky K, McArthur HL, Mittendorf EA, Nanda R, Page DB, Rugo HS, Rubin KM, Soliman H, Spears PA, Tolaney SM, Litton JK. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of breast cancer. J Immunother Cancer 2021; 9:e002597. [PMID: 34389617 PMCID: PMC8365813 DOI: 10.1136/jitc-2021-002597] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Breast cancer has historically been a disease for which immunotherapy was largely unavailable. Recently, the use of immune checkpoint inhibitors (ICIs) in combination with chemotherapy for the treatment of advanced/metastatic triple-negative breast cancer (TNBC) has demonstrated efficacy, including longer progression-free survival and increased overall survival in subsets of patients. Based on clinical benefit in randomized trials, ICIs in combination with chemotherapy for the treatment of some patients with advanced/metastatic TNBC have been approved by the United States (US) Food and Drug Administration (FDA), expanding options for patients. Ongoing questions remain, however, about the optimal chemotherapy backbone for immunotherapy, appropriate biomarker-based selection of patients for treatment, the optimal strategy for immunotherapy treatment in earlier stage disease, and potential use in histological subtypes other than TNBC. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew upon the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for breast cancer, including diagnostic testing, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence-based and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with breast cancer.
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Affiliation(s)
- Leisha A Emens
- Department of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Langone, New York, New York, USA
| | - Ashley Cimino-Mathews
- Department of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary L Disis
- Cancer Vaccine Institute, University of Washington, Seattle, Washington, USA
| | - Margaret E Gatti-Mays
- Pelotonia Institute for Immuno-Oncology, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alice Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin Kalinsky
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rita Nanda
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois, USA
| | - David B Page
- Earle A Chiles Research Institute, Portland, Oregon, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Krista M Rubin
- Center for Melanoma, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Hatem Soliman
- Department of Breast Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Patricia A Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Burstein HJ, Somerfield MR, Barton DL, Dorris A, Fallowfield LJ, Jain D, Johnston SRD, Korde LA, Litton JK, Macrae ER, Peterson LL, Vikas P, Yung RL, Rugo HS. Endocrine Treatment and Targeted Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer: ASCO Guideline Update. J Clin Oncol 2021; 39:3959-3977. [PMID: 34324367 DOI: 10.1200/jco.21.01392] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To update recommendations of the ASCO systemic therapy for hormone receptor (HR)-positive metastatic breast cancer (MBC) guideline. METHODS An Expert Panel conducted a systematic review to identify new, potentially practice-changing data. RESULTS Fifty-one articles met eligibility criteria and form the evidentiary basis for the recommendations. RECOMMENDATIONS Alpelisib in combination with endocrine therapy (ET) should be offered to postmenopausal patients, and to male patients, with HR-positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated, ABC, or MBC following prior endocrine therapy with or without a cyclin-dependent kinase (CDK) 4/6 inhibitor. Clinicians should use next-generation sequencing in tumor tissue or cell-free DNA in plasma to detect PIK3CA mutations. If no mutation is found in cell-free DNA, testing in tumor tissue, if available, should be used as this will detect a small number of additional patients with PIK3CA mutations. There are insufficient data at present to recommend routine testing for ESR1 mutations to guide therapy for HR-positive, HER2-negative MBC. For BRCA1 or BRCA2 mutation carriers with metastatic HER2-negative breast cancer, olaparib or talazoparib should be offered in the 1st-line through 3rd-line setting. A nonsteroidal aromatase inhibitor (AI) and a CDK4/6 inhibitor should be offered to postmenopausal women with treatment-naïve HR-positive MBC. Fulvestrant and a CDK4/6 inhibitor should be offered to patients with progressive disease during treatment with AIs (or who develop a recurrence within 1 year of adjuvant AI therapy) with or without one line of prior chemotherapy for metastatic disease, or as first-line therapy. Treatment should be limited to those without prior exposure to CDK4/6 inhibitors in the metastatic setting.Additional information can be found at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | - Ali Dorris
- Lobular Breast Cancer Research Advocate, San Francisco, CA
| | | | | | | | - Larissa A Korde
- Clinical Investigations Branch, CTEP, DCTD, National Cancer Institute, Bethesda, MD
| | | | | | - Lindsay L Peterson
- Division of Medical Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Praveen Vikas
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA
| | | | - Hope S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
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Hobbs EA, Litton JK, Yap TA. Development of the PARP inhibitor talazoparib for the treatment of advanced BRCA1 and BRCA2 mutated breast cancer. Expert Opin Pharmacother 2021; 22:1825-1837. [PMID: 34309473 DOI: 10.1080/14656566.2021.1952181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION BRCA1 and BRCA2 (BRCA1/2) mutation breast cancers constitute an uncommon, but unique group of breast cancers that present at a younger age, and are underscored by genomic instability and accumulation of DNA damage. Talazoparib is a potent poly(ADP-ribose) polymerase (PARP) inhibitor that exploits impaired DNA damage response mechanisms in this population of patients and results in significant efficacy. Based on the results of the EMBRACA trial, talazoparib was approved for the treatment of patients with advanced germline BRCA1/2 mutant breast cancer. AREAS COVERED In this review, the authors highlight the relevant clinical trials of talazoparib, as well as, safety, tolerability, and quality of life considerations. They also examine putative response and resistance mechanisms, and rational combinatorial therapeutic strategies under development. EXPERT OPINION Talazoparib has been a major advance in the treatment of germline BRCA1/2 mutation breast cancer with both clinical efficacy and improvement in quality of life compared to standard cytotoxic chemotherapy. To date, the optimal sequencing of talazoparib administration in the metastatic setting has not yet been established. A deeper understanding of response and resistance mechanisms, and more broadly, the DNA repair pathway, will lead to additional opportunities in targeting this pathway and open up therapeutic indications to a broader patient population.
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Affiliation(s)
- Evthokia A Hobbs
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer K Litton
- Breast Medical Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy A Yap
- Department of Investigational Cancer Therapeutics (Phase I Program), University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Khalifa Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The Institute for Applied Cancer Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yam C, Yen EY, Chang JT, Bassett RL, Alatrash G, Garber H, Huo L, Yang F, Philips AV, Ding QQ, Lim B, Ueno NT, Kannan K, Sun X, Sun B, Parra Cuentas ER, Symmans WF, White JB, Ravenberg E, Seth S, Guerriero JL, Rauch GM, Damodaran S, Litton JK, Wargo JA, Hortobagyi GN, Futreal A, Wistuba II, Sun R, Moulder SL, Mittendorf EA. Immune Phenotype and Response to Neoadjuvant Therapy in Triple-Negative Breast Cancer. Clin Cancer Res 2021; 27:5365-5375. [PMID: 34253579 DOI: 10.1158/1078-0432.ccr-21-0144] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Increasing tumor-infiltrating lymphocytes (TIL) is associated with higher rates of pathologic complete response (pCR) to neoadjuvant therapy (NAT) in patients with triple-negative breast cancer (TNBC). However, the presence of TILs does not consistently predict pCR, therefore, the current study was undertaken to more fully characterize the immune cell response and its association with pCR. EXPERIMENTAL DESIGN We obtained pretreatment core-needle biopsies from 105 patients with stage I-III TNBC enrolled in ARTEMIS (NCT02276443) who received NAT from Oct 22, 2015 through July 24, 2018. The tumor-immune microenvironment was comprehensively profiled by performing T-cell receptor (TCR) sequencing, programmed death-ligand 1 (PD-L1) IHC, multiplex immunofluorescence, and RNA sequencing on pretreatment tumor samples. The primary endpoint was pathologic response to NAT. RESULTS The pCR rate was 40% (42/105). Higher TCR clonality (median = 0.2 vs. 0.1, P = 0.03), PD-L1 positivity (OR: 2.91, P = 0.020), higher CD3+:CD68+ ratio (median = 14.70 vs. 8.20, P = 0.0128), and closer spatial proximity of T cells to tumor cells (median = 19.26 vs. 21.94 μm, P = 0.0169) were associated with pCR. In a multivariable model, closer spatial proximity of T cells to tumor cells and PD-L1 expression enhanced prediction of pCR when considered in conjunction with clinical stage. CONCLUSIONS In patients receiving NAT for TNBC, deep immune profiling through detailed phenotypic characterization and spatial analysis can improve prediction of pCR in patients receiving NAT for TNBC when considered with traditional clinical parameters.
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Affiliation(s)
- Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Er-Yen Yen
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey T Chang
- Department of Integrative Biology and Pharmacology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gheath Alatrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Haven Garber
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fei Yang
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anne V Philips
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qing-Qing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kasthuri Kannan
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiangjie Sun
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Baohua Sun
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edwin Roger Parra Cuentas
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sahil Seth
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer L Guerriero
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Gaiane M Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Wargo
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stacy L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. .,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Ludwig Center at Harvard, Boston, Massachusetts
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Adrada BE, Candelaria R, Moulder S, Thompson A, Wei P, Whitman GJ, Valero V, Litton JK, Santiago L, Scoggins ME, Moseley TW, White JB, Ravenberg EE, Yang WT, Rauch GM. Early ultrasound evaluation identifies excellent responders to neoadjuvant systemic therapy among patients with triple-negative breast cancer. Cancer 2021; 127:2880-2887. [PMID: 33878210 DOI: 10.1002/cncr.33604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Heterogeneity exists in the response of triple-negative breast cancer (TNBC) to standard anthracycline (AC)/taxane-based neoadjuvant systemic therapy (NAST), with 40% to 50% of patients having a pathologic complete response (pCR) to therapy. Early assessment of the imaging response during NAST may identify a subset of TNBCs that are likely to have a pCR upon completion of treatment. The authors aimed to evaluate the performance of early ultrasound (US) after 2 cycles of neoadjuvant NAST in identifying excellent responders to NAST among patients with TNBC. METHODS Two hundred fifteen patients with TNBC were enrolled in the ongoing ARTEMIS (A Robust TNBC Evaluation Framework to Improve Survival) clinical trial. The patients were divided into a discovery cohort (n = 107) and a validation cohort (n = 108). A receiver operating characteristic analysis with 95% confidence intervals (CIs) and a multivariate logistic regression analysis were performed to model the probability of a pCR on the basis of the tumor volume reduction (TVR) percentage by US from the baseline to after 2 cycles of AC. RESULTS Overall, 39.3% of the patients (42 of 107) achieved a pCR. A positive predictive value (PPV) analysis identified a cutoff point of 80% TVR after 2 cycles; the pCR rate was 77% (17 of 22) in patients with a TVR ≥ 80%, and the area under the curve (AUC) was 0.84 (95% CI, 0.77-0.92; P < .0001). In the validation cohort, the pCR rate was 44%. The PPV for pCR with a TVR ≥ 80% after 2 cycles was 76% (95% CI, 55%-91%), and the AUC was 0.79 (95% CI, 0.70-0.87; P < .0001). CONCLUSIONS The TVR percentage by US evaluation after 2 cycles of NAST may be a cost-effective early imaging biomarker for a pCR to AC/taxane-based NAST.
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Affiliation(s)
- Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rosalind Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stacy Moulder
- Department of Breast Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alastair Thompson
- Department of Breast Surgery, University of Baylor College of Medicine, Houston, Texas.,Lester and Sue Smith Breast Cancer, University of Baylor College of Medicine, Houston, Texas
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary J Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marion E Scoggins
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tanya W Moseley
- Department of Breast Imaging and Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth E Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei T Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gaiane M Rauch
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
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McGrail DJ, Pilié PG, Rashid NU, Voorwerk L, Slagter M, Kok M, Jonasch E, Khasraw M, Heimberger AB, Lim B, Ueno NT, Litton JK, Ferrarotto R, Chang JT, Moulder SL, Lin SY. High tumor mutation burden fails to predict immune checkpoint blockade response across all cancer types. Ann Oncol 2021; 32:661-672. [PMID: 33736924 DOI: 10.1016/j.annonc.2021.02.006] [Citation(s) in RCA: 537] [Impact Index Per Article: 179.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/08/2021] [Accepted: 02/06/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND High tumor mutation burden (TMB-H) has been proposed as a predictive biomarker for response to immune checkpoint blockade (ICB), largely due to the potential for tumor mutations to generate immunogenic neoantigens. Despite recent pan-cancer approval of ICB treatment for any TMB-H tumor, as assessed by the targeted FoundationOne CDx assay in nine tumor types, the utility of this biomarker has not been fully demonstrated across all cancers. PATIENTS AND METHODS Data from over 10 000 patient tumors included in The Cancer Genome Atlas were used to compare approaches to determine TMB and identify the correlation between predicted neoantigen load and CD8 T cells. Association of TMB with ICB treatment outcomes was analyzed by both objective response rates (ORRs, N = 1551) and overall survival (OS, N = 1936). RESULTS In cancer types where CD8 T-cell levels positively correlated with neoantigen load, such as melanoma, lung, and bladder cancers, TMB-H tumors exhibited a 39.8% ORR to ICB [95% confidence interval (CI) 34.9-44.8], which was significantly higher than that observed in low TMB (TMB-L) tumors [odds ratio (OR) = 4.1, 95% CI 2.9-5.8, P < 2 × 10-16]. In cancer types that showed no relationship between CD8 T-cell levels and neoantigen load, such as breast cancer, prostate cancer, and glioma, TMB-H tumors failed to achieve a 20% ORR (ORR = 15.3%, 95% CI 9.2-23.4, P = 0.95), and exhibited a significantly lower ORR relative to TMB-L tumors (OR = 0.46, 95% CI 0.24-0.88, P = 0.02). Bulk ORRs were not significantly different between the two categories of tumors (P = 0.10) for patient cohorts assessed. Equivalent results were obtained by analyzing OS and by treating TMB as a continuous variable. CONCLUSIONS Our analysis failed to support application of TMB-H as a biomarker for treatment with ICB in all solid cancer types. Further tumor type-specific studies are warranted.
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Affiliation(s)
- D J McGrail
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - P G Pilié
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N U Rashid
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA; Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - L Voorwerk
- Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Slagter
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Oncode Institute, Utrecht, The Netherlands
| | - M Kok
- Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Khasraw
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, USA
| | - A B Heimberger
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - B Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J T Chang
- Department of Integrative Biology and Pharmacology, The University of Texas Health Sciences Center at Houston, Houston, USA; Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S-Y Lin
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Elshafeey N, Adrada BE, Candelaria RP, Abdelhafez AH, Musall BC, Sun J, Boge M, Mohamed RM, Mahmoud HS, Son JB, Kotrosou A, Zhang S, Leung J, Lane D, Scoggins M, Spak D, Arribas E, Santiago L, Whitman GJ, Le-Petross HT, Moseley TW, White JB, Ravenberg E, Hwang KP, Wei P, Litton JK, Huo L, Tripathy D, Valero V, Thompson AM, Moulder S, Yang WT, Pagel MD, Ma J, Rauch GM. Abstract PD6-06: Radiomic phenotypes from dynamic contrast-enhanced MRI (DCE-MRI) parametric maps for early prediction of response to neoadjuvant systemic therapy (NAST) in triple negative breast cancer (TNBC) patients. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd6-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and Purpose:Early and accurate assessment ofbreast cancer response to NAST is important for patient management. In this study, we investigated the value of radiomic phenotypes derived from semi-quantitative and quantitative DCE-MRI parametric maps for early prediction of NASTresponse in TNBC patients. MATERIALS AND METHODS:This IRB approved study included 74 patients with stage I-III TNBC who were enrolled in the prospective ARTEMIS trial (NCT02276443). Pathologic complete response (pCR) and non-pCR were assessed by surgical histopathology after NAST (pCR=34; non-pCR=40).MRI scans were obtained at 3 time points during the NAST treatment with every 2-week anthracycline-based chemotherapy (AC): at baseline (BSL=74), post-2 cycles of AC (C2= 27) and post-4 cycles of AC (C4= 27). Patients went on to receive taxane-based chemotherapy prior to surgery. Tumor regions of interest (ROIs) were segmented by a breast radiologist at the early-phase subtractions of DCE-MRI scans using in-house developed software, followed by co-registration of the ROIs with quantitative (Ktrans, Veand Kep), and semi-quantitative DCE parametric maps (Maximum Slope Increase (MSI), Positive Enhancement Integral (PEI) and Peak Signal Enhancement Ratio (SER)).A total of 93 first order radiomic features were extracted from the tumor ROIs of each time point semi-quantitative DCE parametric map, while a total of 390 extracted radiomic features (first order-histogram features and second order grey-level-co-occurrence matrix) were extracted from each quantitative DCE parametric map using an in-house developed Matlab software.Radiomic features at each time point and changes between the 3 time points were compared between pCR and non-pCR using Wilcoxon Rank Sum test and Fisher’s exact test. Area under the receiver operating characteristics curve (AUC) was used to determine which features predicted pCR.Logistic regression was performed for feature selection, and used to build the radiomic phenotype model. The model performance was assessed by leave-one-out cross validation and 3-fold cross validation. RESULTS:Thirty-three radiomic features from PEI map were significantly different between pCR and non-pCR. The PEI most significant features were changesbetween BSL and C4 in skewness, mean and median (AUC=0.87, 0.85 and 0.87, p=<0.001, 0.001 and 0.002 respectively). Additionally, 31 MSI features were significantly different between pCR and non-pCR. The top 2 features were the interscan-change in skewness between BSL and C2 (AUC=0.80, P=0.007) and C4 standard deviation (AUC=0.80, P=0.006). Four BSL Veradiomic features were statistically significant between pCR and non-pCR with the best being range of difference variance (AUC=0.64, P=0.03). One BSL Kepfeature (Angular-Variance of Information measure of correlation-2) was able to differentiate pCR from non-pCR (AUC=0.64, P=0.04). Five C4-Ktrans features were able to differentiate pCR and non-pCR, with the most significant being mean value (AUC=0.86, P=0.001). BSL-Kepradiomic model built from 24 features (AUC=0.80, p=0.003) and combined (Ktrans, Veand Kep)C2-radiomic model consisting of 20 features (AUC=0.97, p=0.01) showed the best performance for prediction of pCR. CONCLUSIONS:Radiomic phenotypes form DCE-MRI parametric maps were useful for differentiation between pCR and non-pCR and showed promise as noninvasive imaging biomarkers for early prediction of NAST response in TNBC. Potentially, DCE-MRI radiomic features may be used for development of diagnostic predictive model for early noninvasive assessment of NAST treatment response in TNBC patients.
Citation Format: Nabil Elshafeey, Beatriz E Adrada, Rosalind P Candelaria, Abeer H Abdelhafez, Benjamin C Musall, Jia Sun, Medine Boge, Rania M.M Mohamed, Hagar S Mahmoud, Jong Bum Son, Aikaterini Kotrosou, Shu Zhang, Jessica Leung, Deanna Lane, Marion Scoggins, David Spak, Elsa Arribas, Lumarie Santiago, Gary J. Whitman, Huong T Le-Petross, Tanya W Moseley, Jason B White, Elizabeth Ravenberg, Ken-Pin Hwang, Peng Wei, Jennifer K Litton, Lei Huo, Debu Tripathy, Vicente Valero, Alastair M Thompson, Stacy Moulder, Wei T Yang, Mark D Pagel, Jingfei Ma, Gaiane M Rauch. Radiomic phenotypes from dynamic contrast-enhanced MRI (DCE-MRI) parametric maps for early prediction of response to neoadjuvant systemic therapy (NAST) in triple negative breast cancer (TNBC) patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD6-06.
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Affiliation(s)
- Nabil Elshafeey
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beatriz E Adrada
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Abeer H Abdelhafez
- 2Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin C Musall
- 3Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States, Houston, TX
| | - Jia Sun
- 4Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States, Houston, TX
| | - Medine Boge
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rania M.M Mohamed
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagar S Mahmoud
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jong Bum Son
- 5Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aikaterini Kotrosou
- 6Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shu Zhang
- 6Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jessica Leung
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deanna Lane
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marion Scoggins
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Spak
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elsa Arribas
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lumarie Santiago
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary J. Whitman
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Huong T Le-Petross
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tanya W Moseley
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason B White
- 7Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Ravenberg
- 7Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ken-Pin Hwang
- 5Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peng Wei
- 5Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer K Litton
- 7Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Huo
- 8Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debu Tripathy
- 7Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vicente Valero
- 7Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Stacy Moulder
- 7Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei T Yang
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark D Pagel
- 10Imaging Physics and Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jingfei Ma
- 5Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gaiane M Rauch
- 11Breast and Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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41
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Rauch GM, Beatriz AE, Candelaria RP, Elshafeey N, Abdelhafez AH, Musall BC, Sun J, Boge M, Mohamed RM, Son JB, Zhang S, Leung J, Lane D, Scoggins M, Spak D, Arribas E, Santiago L, Whitman GJ, Le-Petross HT, Moseley TW, White JB, Ravenberg E, Hwang KP, Wei P, Huo L, Litton JK, Valero V, Tripathy D, Thompson AM, Pagel MD, Ma J, Yang WT, Moulder S. Abstract PD6-07: Volumetric changes on longitudinal dynamic contrast enhanced MR imaging (DCE-MRI) as an early treatment response predictor to neoadjuvant systemic therapy (NAST) in triple negative breast cancer (TNBC) patients. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd6-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and Purpose:There is currently a lack of recognized imaging criteria for prediction of treatment response to NAST in breast cancer patients with recent reports showing that breast MRI is the most accurate modality for evaluation of NAST response. DCE-MRI evaluates tumor perfusion that influences tumor enhancement at the post-contrast subtraction images and allows for more accurate measurement of changes in tumor volume during NAST. In this study, we evaluated the ability of tumor volumetric changes after 2 and 4 cycles of NAST by longitudinal ultrafast DCE-MRI to predict pathologic complete response (pCR) in TNBC undergoing NAST. Materials and Methods: Stage I-III TNBC patients enrolled in an IRB approved prospective clinical trial (ARTEMIS, NCT02276433) who had ultrafast DCE-MRI at baseline (BL, N=103), post 2 cycles (C2, N=59), and post 4 cycles (C4, N=103) of anthracycline-based NAST,and had surgery, were included in this analysis. Tumor volume was calculated using 3D measurements of the index lesion at BL, C2, and C4. Percent change of tumor volume (%TV) between BL, C2, and C4 was calculated at early (9-12 sec) and delayed (360-480 sec) phases of DCE-MRI. The largest lesion was used for analysis in patients with multicentric or multifocal disease. Demographic, clinical, and pathologic data and treatment response at surgery (pCR versus non-pCR) were documented. Receiver operating characteristics curve (ROC) analysis was performed for prediction of pCR status. Positive predictive value (PPV), negative predictive value (NPV) and Youden Index were used to select %TV cut-off thresholds for pCR prediction.Results: 103 patients (median age, 53 years; range, 24-79 years) were included, 48 (47%) had pCR, and 55 (53%) had non-pCR at surgical pathology. The %TV reduction at C2 DCE-MRI was predictive of pCR on both early phase DCE MRI (AUC, 0.873; CI:0.779-0.968, p < .0001) and delayed phase DCE MRI (AUC, 0.844; CI:0.742-0.947, p < .0001). Optimal thresholds were as follows: 70% TV reduction on early phase DCE MRI with Youden’s index of 1.58 was able to predict pCR correctly for 79% of patients with PPV of 81%; 75% TV reduction on delayed phase with Youden’s Index of 1.44 was able to predict pCR correctly for 71% of patients with PPV of 85%.%TV reduction was also predictive of pCR at the C4 time point on both early phase DCE MRI (AUC, 0.761; CI:0.665-0.856, p < .0001) and delayed phase DCE MRI (AUC, 0.737; CI:0.641-0.833, p < .0001). Optimal thresholds were as follows: 90% TV reduction on early phase DCE MRI with Youden’s index of 1.43 was able to correctly predict pCR in 72% of patients with PPV of 70%; and 90% TV reduction on delayed phase with Youden’s Index of 1.34 was able to predict pCR correctly in 68% of patients with PPV of 71%.Conclusion: Our data shows that percent tumor volume reduction by DCE-MRI after 2 and 4 cycles of NAST was able to predict pCR in TNBC with high accuracy and can be used as an early imaging biomarker of NAST response prediction. Volumetric changes by longitudinal DCE-MRI can be used to differentiate chemoresistant and chemosensitive TNBC patients as early as after 2 cycles of NAST, and can help to triage patients for treatment de-escalation or targeted therapy.
Citation Format: Gaiane Margishvili Rauch, Adrada E Beatriz, Rosalind P Candelaria, Nabil Elshafeey, Abeer H Abdelhafez, Benjamin C Musall, Jia Sun, Medina Boge, Rania M.M Mohamed, Jong Bum Son, Shu Zhang, Jessica Leung, Deanna Lane, Marion Scoggins, David Spak, Elsa Arribas, Lumarie Santiago, Gary J Whitman, Huong T. Le-Petross, Tanya W Moseley, Jason B. White, Elizabeth Ravenberg, Ken-Pin Hwang, Peng Wei, Lei Huo, Jennifer K Litton, Vicente Valero, Debu Tripathy, Alastair M Thompson, Mark D Pagel, Jingfei Ma, Wei T Yang, Stacy Moulder. Volumetric changes on longitudinal dynamic contrast enhanced MR imaging (DCE-MRI) as an early treatment response predictor to neoadjuvant systemic therapy (NAST) in triple negative breast cancer (TNBC) patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD6-07.
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Affiliation(s)
| | - Adrada E Beatriz
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Nabil Elshafeey
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abeer H Abdelhafez
- 2Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin C Musall
- 3Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jia Sun
- 4Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Medina Boge
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rania M.M Mohamed
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jong Bum Son
- 3Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shu Zhang
- 5Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jessica Leung
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deanna Lane
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marion Scoggins
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Spak
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elsa Arribas
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lumarie Santiago
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary J Whitman
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Huong T. Le-Petross
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tanya W Moseley
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason B. White
- 6Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Ravenberg
- 6Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ken-Pin Hwang
- 3Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peng Wei
- 4Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lei Huo
- 7Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer K Litton
- 6Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vicente Valero
- 6Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debu Tripathy
- 6Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Mark D Pagel
- 9Imaging Physics and Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jingfei Ma
- 3Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei T Yang
- 1Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stacy Moulder
- 6Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Musall BC, Abdelhafez AH, Adrada BE, Candelaria RP, Mohamed RMM, Boge M, Le-Petross H, Arribas E, Lane DL, Spak DA, Leung JWT, Hwang KP, Son JB, Elshafeey NA, Mahmoud HS, Wei P, Sun J, Zhang S, White JB, Ravenberg EE, Litton JK, Damodaran S, Thompson AM, Moulder SL, Yang WT, Pagel MD, Rauch GM, Ma J. Functional Tumor Volume by Fast Dynamic Contrast-Enhanced MRI for Predicting Neoadjuvant Systemic Therapy Response in Triple-Negative Breast Cancer. J Magn Reson Imaging 2021; 54:251-260. [PMID: 33586845 DOI: 10.1002/jmri.27557] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dynamic contrast-enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response. PURPOSE To investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC). STUDY TYPE Prospective. POPULATION/SUBJECTS Sixty patients with biopsy-confirmed TNBC between December 2016 and September 2020. FIELD STRENGTH/SEQUENCE A 3.0 T/3D fast spoiled gradient echo-based DCE MRI ASSESSMENT: Patients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5-minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing. STATISTICAL TESTS Tumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann-Whitney U test. RESULTS About 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non-pCR, with AUC (95% confidence interval [CI]) = 0.85 (0.74,0.95) (P < 0.05). The 1-minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05). DATA CONCLUSION FTV and TV measured at 1 minute after injection can predict response to NAST in TNBC. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: 4.
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Affiliation(s)
- Benjamin C Musall
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abeer H Abdelhafez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rosalind P Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rania M M Mohamed
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Medine Boge
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Huong Le-Petross
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elsa Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Deanna L Lane
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David A Spak
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica W T Leung
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nabil A Elshafeey
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagar S Mahmoud
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shu Zhang
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth E Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Stacy L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei T Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark D Pagel
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gaiane M Rauch
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Daly MB, Pal T, Berry MP, Buys SS, Dickson P, Domchek SM, Elkhanany A, Friedman S, Goggins M, Hutton ML, Karlan BY, Khan S, Klein C, Kohlmann W, Kurian AW, Laronga C, Litton JK, Mak JS, Menendez CS, Merajver SD, Norquist BS, Offit K, Pederson HJ, Reiser G, Senter-Jamieson L, Shannon KM, Shatsky R, Visvanathan K, Weitzel JN, Wick MJ, Wisinski KB, Yurgelun MB, Darlow SD, Dwyer MA. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:77-102. [DOI: 10.6004/jnccn.2021.0001] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic focus primarily on assessment of pathogenic or likely pathogenic variants associated with increased risk of breast, ovarian, and pancreatic cancer and recommended approaches to genetic testing/counseling and management strategies in individuals with these pathogenic or likely pathogenic variants. This manuscript focuses on cancer risk and risk management for BRCA-related breast/ovarian cancer syndrome and Li-Fraumeni syndrome. Carriers of a BRCA1/2 pathogenic or likely pathogenic variant have an excessive risk for both breast and ovarian cancer that warrants consideration of more intensive screening and preventive strategies. There is also evidence that risks of prostate cancer and pancreatic cancer are elevated in these carriers. Li-Fraumeni syndrome is a highly penetrant cancer syndrome associated with a high lifetime risk for cancer, including soft tissue sarcomas, osteosarcomas, premenopausal breast cancer, colon cancer, gastric cancer, adrenocortical carcinoma, and brain tumors.
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Affiliation(s)
| | - Tuya Pal
- 2Vanderbilt-Ingram Cancer Center
| | - Michael P. Berry
- 3St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Patricia Dickson
- 5Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Michael Goggins
- 9The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Seema Khan
- 12Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | - Holly J. Pederson
- 22Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Litton JK, Hurvitz SA, Mina LA, Rugo HS, Lee KH, Gonçalves A, Diab S, Woodward N, Goodwin A, Yerushalmi R, Roché H, Im YH, Eiermann W, Quek RGW, Usari T, Lanzalone S, Czibere A, Blum JL, Martin M, Ettl J. Talazoparib versus chemotherapy in patients with germline BRCA1/2-mutated HER2-negative advanced breast cancer: final overall survival results from the EMBRACA trial. Ann Oncol 2020; 31:1526-1535. [PMID: 32828825 PMCID: PMC10649377 DOI: 10.1016/j.annonc.2020.08.2098] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In EMBRACA, talazoparib prolonged progression-free survival versus chemotherapy (hazard ratio [HR] 0.542 [95% confidence interval (CI) 0.413-0.711]; P < 0.0001) and improved patient-reported outcomes (PRO) in germline BRCA1/2 (gBRCA1/2)-mutated advanced breast cancer (ABC). We report final overall survival (OS). PATIENTS AND METHODS This randomized phase III trial enrolled patients with gBRCA1/2-mutated HER2-negative ABC. Patients received talazoparib or physician's choice of chemotherapy. OS was analyzed using stratified HR and log-rank test and prespecified rank-preserving structural failure time model to account for subsequent treatments. RESULTS A total of 431 patients were entered in a randomized study (287 talazoparib/144 chemotherapy) with 412 patients treated (286 talazoparib/126 chemotherapy). By 30 September 2019, 216 deaths (75.3%) occurred for talazoparib and 108 (75.0%) chemotherapy; median follow-up was 44.9 and 36.8 months, respectively. HR for OS with talazoparib versus chemotherapy was 0.848 (95% CI 0.670-1.073; P = 0.17); median (95% CI) 19.3 months (16.6-22.5 months) versus 19.5 months (17.4-22.4 months). Kaplan-Meier survival percentages (95% CI) for talazoparib versus chemotherapy: month 12, 71% (66% to 76%)/74% (66% to 81%); month 24, 42% (36% to 47%)/38% (30% to 47%); month 36, 27% (22% to 33%)/21% (14% to 29%). Most patients received subsequent treatments: for talazoparib and chemotherapy, 46.3%/41.7% received platinum and 4.5%/32.6% received a poly(ADP-ribose) polymerase (PARP) inhibitor, respectively. Adjusting for subsequent PARP and/or platinum use, HR for OS was 0.756 (95% bootstrap CI 0.503-1.029). Grade 3-4 adverse events occurred in 69.6% (talazoparib) and 64.3% (chemotherapy) patients, consistent with previous reports. Extended follow-up showed significant overall improvement and delay in time to definitive clinically meaningful deterioration in global health status/quality of life and breast symptoms favoring talazoparib versus chemotherapy (P < 0.01 for all), consistent with initial analyses. CONCLUSIONS In gBRCA1/2-mutated HER2-negative ABC, talazoparib did not significantly improve OS over chemotherapy; subsequent treatments may have impacted analysis. Safety was consistent with previous observations. PRO continued to favor talazoparib.
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Affiliation(s)
- J K Litton
- The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - S A Hurvitz
- University of California, Los Angeles/Jonsson Comprehensive Cancer Center, Los Angeles, USA
| | - L A Mina
- Banner M.D. Anderson Cancer Center, Gilbert, USA
| | - H S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - K-H Lee
- Seoul National University Hospital, Seoul, South Korea
| | | | - S Diab
- Rocky Mountain Cancer Centers, Littleton, USA
| | - N Woodward
- Mater Misericordiae Ltd/Mater Research Institute and the University of Queensland, Brisbane, Australia
| | - A Goodwin
- Medical Oncology Department, Concord Repatriation General Hospital, Concord, Australia
| | - R Yerushalmi
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - H Roché
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Y-H Im
- Samsung Medical Center, Seoul, South Korea
| | - W Eiermann
- Interdisziplinäres Onkologisches Zentrum München, Munich, Germany
| | | | - T Usari
- Pfizer Oncology, Milan, Italy
| | | | | | - J L Blum
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas, USA
| | - M Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - J Ettl
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Yam C, Rauch GM, Rahman T, Karuturi M, Ravenberg E, White J, Clayborn A, McCarthy P, Abouharb S, Lim B, Litton JK, Ramirez DL, Saleem S, Stec J, Symmans WF, Huo L, Damodaran S, Sun R, Moulder SL. A phase II study of Mirvetuximab Soravtansine in triple-negative breast cancer. Invest New Drugs 2020; 39:509-515. [PMID: 32984932 DOI: 10.1007/s10637-020-00995-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022]
Abstract
Folate receptor alpha (FRα) has been reported to be expressed in up to 80% of triple-negative breast cancers (TNBC) with limited expression in normal tissues, making it a promising therapeutic target. Mirvetuximab soravtansine (mirvetuximab-s) is an antibody drug conjugate which has shown promise in the treatment of FRα-positive solid tumors in early phase clinical trials. Herein, are the results of the first prospective phase II trial evaluating mirvetuximab-s in metastatic TNBC. Patients with advanced, FRα-positive TNBC were enrolled on this study. Mirvetuximab-s was administered at a dose of 6.0 mg/kg every 3 weeks. 96 patients with advanced TNBC consented for screening. FRα staining was performed on tumor tissue obtained from 80 patients. The rate of FRα positivity by immunohistochemistry was 10.0% (8/80). Two patients were treated on study, with best overall responses of stable disease in one and progressive disease in the other. Adverse events were consistent with earlier studies. The study was terminated early due to the low rate of FRα positivity in the screened patient population and lack of disease response in the two patients treated. The observed rate of FRα positivity was considerably lower than previously reported and none of the patients had a partial or complete response. Treatment with mirvetuximab-s should only be further explored in TNBC if an alternate biomarker strategy is developed for patient selection on the basis of additional preclinical data.
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Affiliation(s)
- Clinton Yam
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Gaiane M Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tanbin Rahman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Meghan Karuturi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Elizabeth Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Jason White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Alyson Clayborn
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Pamela McCarthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Sausan Abouharb
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - David L Ramirez
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Sadia Saleem
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | | | - W Fraser Symmans
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stacy L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building CPB5.3542, 1515 Holcombe Blvd. Unit 1354, Houston, TX, 77030, USA.
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Abdelhafez AH, Musall BC, Adrada BE, Hess K, Son JB, Hwang KP, Candelaria RP, Santiago L, Whitman GJ, Le-Petross HT, Moseley TW, Arribas E, Lane DL, Scoggins ME, Leung JWT, Mahmoud HS, White JB, Ravenberg EE, Litton JK, Valero V, Wei P, Thompson AM, Moulder SL, Pagel MD, Ma J, Yang WT, Rauch GM. Tumor necrosis by pretreatment breast MRI: association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC). Breast Cancer Res Treat 2020; 185:1-12. [PMID: 32920733 DOI: 10.1007/s10549-020-05917-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine if tumor necrosis by pretreatment breast MRI and its quantitative imaging characteristics are associated with response to NAST in TNBC. METHODS This retrospective study included 85 TNBC patients (mean age 51.8 ± 13 years) with MRI before NAST and definitive surgery during 2010-2018. Each MRI included T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. For each index carcinoma, total tumor volume including necrosis (TTV), excluding necrosis (TV), and the necrosis-only volume (NV) were segmented on early-phase DCE subtractions and DWI images. NV and %NV were calculated. Percent enhancement on early and late phases of DCE and apparent diffusion coefficient were extracted from TTV, TV, and NV. Association between necrosis with pathological complete response (pCR) was assessed using odds ratio (OR). Multivariable analysis was used to evaluate the prognostic value of necrosis with T stage and nodal status at staging. Mann-Whitney U tests and area under the curve (AUC) were used to assess performance of imaging metrics for discriminating pCR vs non-pCR. RESULTS Of 39 patients (46%) with necrosis, 17 had pCR and 22 did not. Necrosis was not associated with pCR (OR, 0.995; 95% confidence interval [CI] 0.4-2.3) and was not an independent prognostic factor when combined with T stage and nodal status at staging (P = 0.46). None of the imaging metrics differed significantly between pCR and non-pCR in patients with necrosis (AUC < 0.6 and P > 0.40). CONCLUSION No significant association was found between necrosis by pretreatment MRI or the quantitative imaging characteristics of tumor necrosis and response to NAST in TNBC.
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Affiliation(s)
- Abeer H Abdelhafez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Benjamin C Musall
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1472, Houston, TX, 77030, USA
| | - Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - KennethR Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1411, Houston, TX, 77030, USA
| | - Jong Bum Son
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1472, Houston, TX, 77030, USA
| | - Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1472, Houston, TX, 77030, USA
| | - Rosalind P Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Gary J Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Huong T Le-Petross
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Tanya W Moseley
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Elsa Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Deanna L Lane
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Marion E Scoggins
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Jessica W T Leung
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Hagar S Mahmoud
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Jason B White
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Elizabeth E Ravenberg
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1411, Houston, TX, 77030, USA
| | - Alastair M Thompson
- Department of Surgery, Baylor College of Medicine, 7200 Cambridge St., Houston, TX, 77030, USA
| | - Stacy L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX, 77030, USA
| | - Mark D Pagel
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1472, Houston, TX, 77030, USA.,Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1907, Houston, TX, 77030, USA
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1472, Houston, TX, 77030, USA
| | - Wei T Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA
| | - Gaiane M Rauch
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA. .,Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1473, Houston, TX, 77030, USA.
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Litton JK, Laird AD, Rugo HS, Ettl J, Hurvitz SA, Martin M, Roché H, Im YH, Goodwin A, Blum JL, Eiermann W, Chen Y, Lanzalone S, Chelliserry J, Czibere A, Albacker LA, Frampton GM, Mina LA. Abstract CT072: Exploration of impact of tumor BRCA zygosity and genomic loss-of-heterozygosity (gLOH) on efficacy in Phase 3 EMBRACA study of talazoparib in patients (pts) with HER2-negative (HER2−) advanced breast cancer (ABC) and a germline BRCA1/2 (g BRCA1/2) mutation. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Loss-of-function mutations in genes encoding components of the homologous recombination machinery, notably BRCA1/2, are associated with tumor sensitivity to poly(ADP-ribose) polymerase (PARP) inhibitors. In EMBRACA, the PARP inhibitor talazoparib (TALA) demonstrated a significant improvement in the primary endpoint of progression-free survival (PFS) (HR [95% CI] 0.54 [0.41-0.71], P < 0.001) vs physician's choice of chemotherapy (PCT) in pts with HER2− ABC and a gBRCA1/2 mutation.
Methods: Baseline tumor tissue (primary or metastatic sites) from 308 pts (71%) in the intent-to-treat population was sequenced using the FoundationOne CDx NGS panel. Mutations summarized below were known/likely pathogenic single-nucleotide variants, insertions, deletions, or rearrangements. Additional exploratory computational analyses pertinent to homologous recombination deficiency were performed, including somatic-germline-zygosity (SGZ) and gLOH assessments.
Results: 296/308 (96%) of evaluable pts exhibited ≥1 tumor BRCA mutation, with BRCA1 and BRCA2 mutations mainly mutually exclusive (4/308 [1%] pts had both BRCA1 and BRCA2 mutations). Of 12 pts with no apparent BRCA mutations, 7 exhibited tumor BRCA copy number alterations deemed pathogenic and 2 had BRCA single-nucleotide variants deemed of unknown pathogenicity. 195/236 (83%) BRCA-mutant (BRCAm) pts evaluable for BRCA LOH status were predicted to exhibit BRCA LOH by SGZ analysis. The potential impact of tumor BRCA mutational zygosity on PFS was explored in the TALA arm calculating HR by Cox proportional hazards model, comparing 122 pts with BRCA LOH with 27 pts without BRCA LOH. This analysis demonstrated no difference in PFS [HR (95% CI): 1.152 (0.680-1.951); P = 0.597)]. gLOH scores were variable, but mostly high: median (range), 21.8% (0.0, 52.7) and 20.5% (0.2, 40.5) for TALA and PCT arms, respectively. The potential association of gLOH scores with selected measures of efficacy was explored. Within both arms gLOH was similar in those pts achieving vs pts not achieving clinical benefit as defined by complete response, partial response, or stable disease ≥24 wks per RECIST v.1.1 as determined by investigator (P = 0.976 and 0.492, respectively, using 2-tailed t-test). In both arms, pts with gLOH ≥ median vs gLOH < median exhibited similar PFS: HR (95% CI) 1.247 (0.828-1.879) for TALA; 1.238 (0.693-2.211) for PCT, with HR <1 favoring gLOH ≥ median.
Conclusions: Selection based on gBRCA mutational status is appropriate to identify HER2− ABC pts with potential for clinical benefit with PARP inhibitors, with tumor BRCA zygosity and gLOH not impacting outcome (within the gBRCAm subset). Additional exploratory correlative analyses are ongoing and will be reported.
Citation Format: Jennifer K. Litton, A. Douglas Laird, Hope S. Rugo, Johannes Ettl, Sara A. Hurvitz, Miguel Martin, Henri Roché, Young-Hyuck Im, Annabel Goodwin, Joanne L. Blum, Wolfgang Eiermann, Ying Chen, Silvana Lanzalone, Jijumon Chelliserry, Akos Czibere, Lee A. Albacker, Garrett M. Frampton, Lida A. Mina. Exploration of impact of tumor BRCA zygosity and genomic loss-of-heterozygosity (gLOH) on efficacy in Phase 3 EMBRACA study of talazoparib in patients (pts) with HER2-negative (HER2−) advanced breast cancer (ABC) and a germline BRCA1/2 (gBRCA1/2) mutation [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT072.
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Affiliation(s)
| | | | - Hope S. Rugo
- 3University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Johannes Ettl
- 4Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sara A. Hurvitz
- 5University of California, Los Angeles/Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Miguel Martin
- 6Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Henri Roché
- 7Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | | | - Annabel Goodwin
- 9Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Joanne L. Blum
- 10Texas Oncology–Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas, TX
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Postel-Vinay S, Lam VK, Ros W, Bauer TM, Hansen AR, Cho DC, Hodi FS, Schellens JH, Litton JK, Aspeslagh S, Autio KA, Opdam FL, McKean M, Somaiah N, Champiat S, Altan M, Spreafico A, Rahma O, Paul EM, Ahlers CM, Zhou H, Struemper H, Gorman SA, Watmuff M, Yablonski KM, Yanamandra N, Chisamore MJ, Schmidt EV, Hoos A, Marabelle A, Weber JS, Heymach JV. Abstract CT150: A first-in-human phase I study of the OX40 agonist GSK3174998 (GSK998) +/- pembrolizumab in patients (Pts) with selected advanced solid tumors (ENGAGE-1). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: OX40 is a costimulatory receptor transiently expressed on the surface of activated T cells and some innate immune cells (e.g. NK cells). OX40 agonists have been shown to increase antitumor immunity and improve tumor-free survival in preclinical models, demonstrating increased efficacy when given in combination with a PD-1 inhibitor. GSK998 is a humanized IgG1 agonistic OX40 monoclonal antibody. Methods: ENGAGE-1 (NCT02528357) is a Phase 1 dose escalation study evaluating safety, PK, PD, and clinical activity of GSK998 (0.003-10 mg/kg IV Q3W) alone (Part 1) and in combination with pembrolizumab 200 mg IV Q3W (Part 2) in pts with previously treated advanced solid tumors: non-small cell lung cancer (NSCLC), squamous cell carcinoma of the head and neck, renal cell carcinoma, melanoma (MEL), bladder cancer, soft tissue sarcoma (STS), triple-negative breast cancer, and MSI-high colorectal carcinoma. Dose escalation used a continuous reassessment method and 4-week DLT period. Results: A total of 138 pts were enrolled (45 Part 1, 96 Part 2; 3 crossed over from Part 1). Two DLTs occurred in Part 2 only (G3 non-malignant pleural effusion 0.03 mg/kg; G1 myocarditis 10 mg/kg); MTD was not established. Most common (≥10%) treatment-related AEs (mostly G1-2) were diarrhea, fatigue (Part 1) and fatigue, nausea (Part 2). GSK998 demonstrated target engagement in the periphery as evidenced by PK and receptor occupancy (RO); a dose of 0.3 mg/kg was the threshold for linear PK & peripheral RO saturation over the 3-wk dose interval and was selected for further clinical evaluation in MEL, STS, and NSCLC in Part 2 expansion. Clinical responses and SD ≥24 weeks were observed in both PD-1/L1 naïve and experienced pts: Part 1 (1 PR, 1 SD; both 0.3 mg/kg) and Part 2 (2 CR, 7 PR, 9 SD; 0.01-3 mg/kg); Part 2 clinical responses were not correlated with baseline tumor PD-L1 expression levels; including one MEL pt with PD-L1 TPS=0 who progressed on prior CTLA-4/PD-1 treatment and had a CR (>18mo). Overall, peripheral and tumor expression of OX40 was low (<2% total cells in tumor were OX40 +ve). MultiOmyxTM data from tumor biopsies suggested increased NK/decreased Treg involvement in some responders. Conclusions: GSK998 +/- pembrolizumab was well tolerated, with evidence of target engagement; monotherapy clinical activity was limited. While combination responses may not be significantly greater than expected for pembrolizumab alone, responses were observed in some PD-1/L1 experienced pts and some with low PD-L1 expression. Given the low OX40 expression observed and preclinical evidence that increased expression improves activity of OX40 agonism, ongoing clinical evaluation of GSK998 will assess whether concurrent immune-stimulation or immunogenic cell death impacts OX40 expression and increases the efficacy of this agent. Combinations with TLR4 and ICOS agonists and an anti-BCMA antibody-drug conjugate are ongoing.
Citation Format: Sophie Postel-Vinay, Vincent K. Lam, Willeke Ros, Todd M. Bauer, Aaron R. Hansen, Daniel C. Cho, F. Stephen Hodi, Jan H.M. Schellens, Jennifer K. Litton, Sandrine Aspeslagh, Karen A. Autio, Frans L. Opdam, Meredith McKean, Neeta Somaiah, Stephane Champiat, Mehmet Altan, Anna Spreafico, Osama Rahma, Elaine M. Paul, Christoph M. Ahlers, Helen Zhou, Herbert Struemper, Shelby A. Gorman, Maura Watmuff, Kaitlin M. Yablonski, Niranjan Yanamandra, Michael J. Chisamore, Emmett V. Schmidt, Axel Hoos, Aurélien Marabelle, Jeffrey S. Weber, John V. Heymach. A first-in-human phase I study of the OX40 agonist GSK3174998 (GSK998) +/- pembrolizumab in patients (Pts) with selected advanced solid tumors (ENGAGE-1) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT150.
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Affiliation(s)
| | - Vincent K. Lam
- 2The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Willeke Ros
- 3Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Todd M. Bauer
- 4Sarah Cannon Research Institute/TN Oncology, Nashville, TN
| | | | - Daniel C. Cho
- 6Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY
| | | | - Jan H.M. Schellens
- 3Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | | | | | - Frans L. Opdam
- 3Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Neeta Somaiah
- 2The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Mehmet Altan
- 2The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anna Spreafico
- 5Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jeffrey S. Weber
- 6Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY
| | - John V. Heymach
- 2The University of Texas MD Anderson Cancer Center, Houston, TX
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Seth S, Huo L, Rauch GM, Adrada B, Piwnica-Worms H, Lim B, Thompson AM, Mittendorf EA, Heffernan T, Litton JK, Symmans WF, Draetta GF, Futreal AP, Chang JT, Moulder SL. Abstract 1497: Longitudinal response and selection under neoadjuvant systemic therapy (NAST) in triple-negative breast cancer (TNBC): Profiling results from a randomized trial (ARTEMIS; NCT02276443). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The heterogeneity of TNBC results in a spectrum of responses to NAST: 30-40% of patients (pts) have a pathologic complete response (pCR) with an excellent prognosis. Several methods have been used to measure and evaluate residual disease, including ultrasound, MRI scans, histo-pathology. In addition to these, we hypothesize that comprehensive molecular profiling of longitudinal biopsies, with an integrative evaluation of sub-clonal selection and changes in molecular pathways, will serve as a critical biomarker for chemotherapy, and subsequent targeted therapy trials.
Methods: Pts with stage I-III TNBC began a planned 4 cycles of Adriamycin-based chemo (AC). Biopsies were performed pre (mandatory) and post (optional) AC. Volumetric change by ultrasound (VUS) at completion of AC (or progression) was calculated. Pts with sensitive disease received subsequent taxane-based (T) therapy. Pts with insensitive disease were offered phase II trials. Pathologic response was assessed at surgical resection in 85 pts (Training N=55, Validation N=30). Matched samples, pre and post AC (N = 85 pts) underwent transcriptomic and genomic profiling. Samples were classified into six previously identified ARTEMIS subtypes of TNBC (ART-Type) and immune deconvolution and estimation were performed using RNA-Seq profiles. Multiplex IHC using the Vectra platform is being used to validate results from bulk RNASeq experiments. Somatic mutations and copy-number changes were evaluated using, Mutect2, Sequenza (and FACETs), and PhyloWGS (and PyClone).
Results: Predominately, tumors reacted to AC in 4 different patterns with variation in immune and EMT related pathways. Enrichment of EMT (Group 4) was associated with poor prognosis and higher RCB (10.3% vs 42% pCR rates, p<0.05). The global changes in transcription led to ART-Type switching in all subtypes (44% of pts), except LAR subtype. This subtype was enriched in Group 3 (low overall change), and associated with PIK3CA mutations. MYC amplification was more prevalent (40%) in Group 4, associated with higher EMT and poor prognosis than other groups (28%). Multiple time points were leveraged to constrain sub-clonal clustering and enhance the accuracy of phylogenetic tree construction. Significant sub-clonal selection was detected in 22% of evaluable cases with pre and post biopsies (N=55), with analysis of the validation cohort underway. Molecular subtypes were marginally associated with overall and progression-free survival.
Conclusions: Molecular profiling of longitudinal TNBC samples reveals distinct response patterns in tumors and their micro-environments upon treatment with AC. Integrative analysis of genomic and transcriptomic changes can lead to better stratification of response to NAST. These patterns were indicative of pathologic response in the initial cohort (N=55). Analysis of the second cohort (N=30) will be presented as a validation cohort.
Citation Format: Sahil Seth, Lei Huo, Gaiane M. Rauch, Beatriz Adrada, Helen Piwnica-Worms, Bora Lim, Alastair M. Thompson, Elizabeth A. Mittendorf, Timothy Heffernan, Jennifer K. Litton, William F. Symmans, Giulio F. Draetta, Andrew P. Futreal, Jeffrey T. Chang, Stacy L. Moulder. Longitudinal response and selection under neoadjuvant systemic therapy (NAST) in triple-negative breast cancer (TNBC): Profiling results from a randomized trial (ARTEMIS; NCT02276443) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1497.
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Affiliation(s)
- Sahil Seth
- 1UT MD Anderson Cancer Center, Houston, TX
| | - Lei Huo
- 1UT MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Bora Lim
- 1UT MD Anderson Cancer Center, Houston, TX
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Litton JK, Hurvitz SA, Mina LA, Rugo HS, Lee KH, Gonçalves A, Diab S, Woodward N, Goodwin A, Yerushalmi R, Roché H, Im YH, Eiermann W, Quek RG, Usari T, Lanzalone S, Czibere A, Blum JL, Martin M, Ettl J. Abstract CT071: Talazoparib (TALA) in germlineBRCA1/2(gBRCA1/2)-mutated human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer (ABC): Final overall survival (OS) results from randomized Phase 3 EMBRACA trial. Tumour Biol 2020. [DOI: 10.1158/1538-7445.am2020-ct071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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